DM血糖达标__培训课件.pptVIP

* * * * * * * Diagnosis of type 2 diabetes may occur years after its onset and, by the time of diagnosis, serious complications have often already developed.1 In addition, on average 50% of pancreatic β-cell function has already been lost by the time of diagnosis.2 Despite the need for intensive management strategies to delay further progression of the disease and to reduce loss of glycemic control, studies have shown that the majority of patients do not achieve HbA1c goals.3,4 Only approximately 25% of patients in the UKPDS treated with monotherapy achieved their glycemic goals after 9 years and required polypharmacy.5 1UKPDS Group. Diabetologia 1991; 34:877–890.2Holman RR. Diabetes Res Clin Prac 1998; 40 (Suppl.):S21–S25. 3Saydah SH, et al. JAMA 2004; 291:335–342.4Liebl A, et al. Diabetologia 2002; 45:S23–S28.5Turner RC, et al. JAMA 1999; 281:2005–2012. * Given the drawbacks of the traditional stepwise approach, there is a strong rationale for earlier use of combination therapy. Earlier introduction of combination therapy offers the potential for therapeutic goals to be achieved more rapidly than with conventional stepwise management, thus reducing the risks associated with extended periods of poor glycemic control. Combination therapy with sub-maximal doses of oral antidiabetic agents may offer improved safety and tolerability compared with monotherapy with a single agent titrated to maximal doses. Combination therapy with agents with complementary mechanisms of action is likely to have additional benefits for the long-term management of type 2 diabetes. Combining agents that target the dual defects of insulin resistance and β-cell function that underlie type 2 diabetes has the potential to maintain good glycemic control in the long term and to delay or prevent disease progression. * The Global Partnership recommends a new paradigm for early combination treatment that incorporates the following recommendations:1 treat patients intensively so as to achiev