糖尿病及降糖药物详解演示文稿.pptVIP

拜耳医药公司在新近的医学论坛报上刊登了一篇“阿卡波糖——着眼餐后、真正强化血糖控制”的访谈文章,文章将餐后高血糖的意义作了无实证证据支持的夸大。以下就该访谈中片面夸大“餐后高血糖”的观点逐一进行批驳。 Comparing the effects of the marketing Oral Antidiabetic drugs, The effects in reducing glycemic parameters with TZDs seems comparable to that with Metformin or sulfonylurea, at least in short term therapy, but meta analysis showed there could be better control with TZDs than with metformin (Clinical Ther. 2004; 26:805), although the perspective clinical researches on effects of TZD in glycemic parameter, comparing Metformin, in long term is going on. The benefits of TZD therapy is in emphasis on dyslipidemia, reduction of TG and increase HDL will bring more benefits to patients. The lack of effects on LDL-C seems not to produce some risk to diabetic patients, because of reduction of sdLDL and increase of buoy LDL, after TZD therapy. In term of different mechanism of improvement of glycemic parameters for TZD and metformin, it is proven that the predominant effect of metformin is inhibition of hepatic glucose production, whereas the primary effect of TZDs is reduction of insulin resistance and promotion of peripheral glucose uptake.(Clinical Ther. 2004; 26:805) 由于服用拜唐苹的最终结局无非是使碳水化合物吸收减少，而饮食控制也可在一定程度上达到此种目的。加之病人对拜唐苹的耐受性也极差，如 UKPDS 研究中就发现患者服用拜唐苹的退出率就极高。同时在《ADA专家委员会对糖尿病的诊断与分类》中也认为拜唐苹的肠道不良反应（指胀气、排气等）严重。因此加用拜唐苹并非理想选择。 2型糖尿病的发病机制主要是在遗传基础上综合多种因素的后果。其中胰岛β细胞分泌功能损伤和胰岛素抵抗作用同时存在,而且为主要环节。遗传基因、不良生活习惯和高血糖毒性会既造成β细胞的损伤又造成胰岛素的抵抗。胰岛β细胞的功能损伤会引致胰岛素分泌量的下降，胰岛素的抵抗作用会使组织对胰岛素的敏感性下降。它们共同导致肝糖元输出的增多和肌肉、脂肪组织对糖利用能力的下降，继而出现餐后和空腹的高血糖血症。长期的高血糖血症造成的糖毒性和高胰岛素血症再反过来影响β细胞的功能和胰岛素的抵抗。从而出现恶性循环。 餐后血糖是指吃饭后的任何时间 OGTT :2小时内的血糖 Comparing the effects of the marketing Oral Antidiabetic drugs, The effects in reducing glycemic parameters with TZDs seems comparable to that with Metformin or sulfonylurea, at least in short term therapy, but meta analysis showed there could be better control with TZDs than with metformin (Clinical Ther. 2004; 26:805), although the perspective clinical researches on effect