糖尿病防治新进展.ppt

给予换用来得时胰岛素降血糖治疗。第95页,共99页，5月，星期六，2024年，5月第96页,共99页，5月，星期六，2024年，5月联系方式宝鸡市中心医院肾病内分泌科宝鸡市糖尿病防治中心门诊时间:每周星期2上午

电话:0917-3397494第97页,共99页，5月，星期六，2024年，5月第98页,共99页，5月，星期六，2024年，5月感谢大家观看第99页,共99页，5月，星期六，2024年，5月**糖尿病患病率在过去20年中上升了4倍。需要指出的是，这几次的调查方法和诊断标准是不一致的，特别是在1997年后糖尿病诊断的空腹血糖切点从≥7.8mmol/l改为≥7.0mmol/l。因此，表中前3次的调查结果与现在的指标比较起来是低估的。***Thefirststepafterdiagnosisoftype2diabetesshouldbetorecommendlifestylemodificationstakingethnicandculturaldifferencesintoconsideration.Mostpeoplewithtype2diabeteswillfailtoachieveormaintainglycemicgoalsusinglifestylemeasuresalonebecauseoffailuretoloseweight,weightregain,progressivediseaseoracombinationofthesefactors.Onthebasisofthisunderstanding,metforminshouldbeinitiatedconcurrentlywithlifestylechangesandtitratedtoitsmaximallyeffectiveandtolerateddoseoveraperiodof1–2months.Otherglucose-loweringagentsshouldbeconsideredassoonaspersistenthyperglycemiaisapparent.NathanDM,etal.Managementofhyperglycaemiaintype2diabetes:aconsensusalgorithmfortheinitiationandadjustmentoftherapy.AconsensusstatementfromtheAmericanDiabetesAssociationandtheEuropeanAssociationfortheStudyofDiabetes.Diabetologia2006;49:1711–21.**IfStep1failstoachieveand/ormaintainHbA1clevelsof7%,thepromptadditionoffurthermedicationshouldbeconsideredtoavoidprolongedperiodsofhyperglycemia.ThemainfactoraffectingthechoiceofsecondagentshouldbeHbA1clevel.Inpatientswithlevels8.5%,initiationofinsulintherapywithabasalinsulinsuchasinsulinglargineisthemosteffectiveoption.Thosepatientswithvaluesclosertotargetlevels(HbA1c7.5%)canbetreatedwithagentssuchasoralantidiabetesdrugsthathavealesserpotentialtolowerglycemia.Itisimportanttoreiterateherethattheadditionofmedicationsintype2diabetesistheruleandnottheexce