糖尿病及其进展PPT.ppt

此观察同样发现给那格列奈之后快速出现胰岛素高峰，到2小时时已恢复至正常。而瑞格列奈的高峰到2小时左右才出现，类似于磺脲类药物。 接下来我们看一下唐力对中国患者的疗效和安全性。在中国进行的多中心III期临床研究中比较了推荐剂量的唐力120mgtid和双倍常用剂量阿卡波糖，即100mgtid降低HbA1c的疗效。治疗12周后与基础值比较，HbA1c平均分别下降-0.90％和-0.83％，唐力优于阿卡波糖组，无统计学差异，说明唐力在临床应用中更具药物经济学效益。 这里针对糖尿病患者的2种血糖问题，应用基础治疗针对空腹血糖治疗，应用餐时治疗针对餐后血糖。 Recognizing the recommendations and goals of the ADA and ACE, how should we treat our patients to try to attain them with minimal risk? It now appears that the ideal strategy may be what’s called basal-bolus treatment, aimed to decrease both fasting and postprandial glucose levels. Bolus therapy is aimed at the postprandial glucose excursions after each meal, and basal therapy is aimed at fasting hyperglycemia. Basal-bolus therapy is logical for several reasons. 基础-餐时治疗的概念：基础治疗应用胰岛素增敏剂模拟长效胰岛素，餐时治疗应用?-细胞增强剂模拟短效胰岛素的作用。胰岛素增敏剂 可以选择二甲双胍和/或噻唑烷二酮类的药物，?-细胞增强剂有2种选择：可以选择每日一次的长效磺脲类药物如格列本脲，或者可以选择随餐服用的药物如那格列奈, 瑞格列奈，但是餐时服用的药物更符合生理情况，因为低血糖风险低，而且那格列奈引起低血糖的危险低于瑞格列奈。 What should basal-bolus therapy consist of? Logically, the basal, fasting component, would be an insulin sensitizer to improve the action of the patient’s own insulin, or a long-acting insulin if the patient needs insulin. The bolus, before meals component, would be either a beta cell enhancer, or short-acting insulin if the patient needs insulin. What the insulin sensitizer does, is improve the effect of basal insulin that the patient is still able to make. This can be accomplished with either metformin and/or a TZD, a glitazone. Beta cell enhancer choices include once-a-day therapy with a long-acting sulfonylurea such as glyburide, or medications given with meals such as nateglinide or repaglinide. Mealtime therapy turns out to be the most physiologic and carries the least risk of hypoglycemia. In head-to-head trials nateglinide produces less hypoglycemia compared to repaglinide. 在2004年，作者发表了上述研究在既往未经治疗的患者的亚组分析。共有401例患者符合未经治疗的条件，其中在那格列奈，二甲双胍，联合治疗和安慰剂组的患者数分别为104，104，89和104例。各组之间HbA1c、空腹血糖、餐后2小时血糖基线水平基本相似，平均年龄为58岁，BMI为30 kg/m2，糖尿病的病程为