2型糖尿病的早期防治策略课件.ppt

Despite increasingly stringent clinical practice guidelinesfor glycaemic control, the implementation of recommendations has been disappointing, with over 60% of patientsnot reaching recommended glycaemic goals. As a result,current management of glycaemia falls significantly short of accepted treatment goals. The Global Partnership for Effective Diabetes Management has identified a number of major barriers that can prevent individuals from achieving their glycaemic targets. This article proposes 10 key practical recommendations to aid healthcare providers in overcoming these barriers and to enable a greater proportion of patients to achieve glycaemic goals. These include advice on targeting the underlying pathophysiology of type 2 diabetes, treating early and effectively with combination therapies, adopting a holistic, multidisciplinary approach and improving patient understanding of type 2 diabetes. Implementation of these recommendations should reduce the risk of diabetes-related complications, improve patient quality of life and impact more effectively on the increasing healthcare cost related to diabetes * ESC/EASD Eur Heart J 2007 ; 28: 88-136. ESC/EASD糖尿病、糖尿病前期和心血管病联合指南 基于不同代谢状态选择药物 阿卡波糖着眼餐后，有效降低空腹血糖和HbA1c 在2型糖尿病和糖耐量减低患者中使用阿卡波糖，平均治疗13.9周 检测值(mg/dL) 检测值(%) 1.4 92.2 38.5 1.4 N=2250 Chang YP, et al. Clin Drug Invest 2007; 27 (6): 397-405 DPP－IV抑制剂注册临床试验初诊2型糖尿病患者，阿卡波糖显著降低HbA1c可达1.3% 一项随机、双盲、对照研究，入选31家中心（其中15家在中国）初诊2型糖尿病患者，基线HbA1c为8.6%，糖尿病病程1.2~1.3年。给予DPP-4抑制剂(100mg/d, bid，n=441)vs.阿卡波糖(300mg/dtid，n=220)，治疗24周 平均 HbA1c(%) Diabet Med. 2008 Apr;25(4):435-41. 降低 1.3% 2型糖尿病治疗路径图α－糖苷酶抑制剂：一线起始 全程推荐 2010《中国2型糖尿病防治指南》讨论稿 如血糖控制不达标(HbA1c7.0%)，则进入下一步治疗 主要治疗路径 备选治疗路径 二甲双胍 胰岛素促分泌剂或α-糖苷酶抑制剂 基础胰岛素 或 预混胰岛素 胰岛素促分泌剂 或 α-糖苷酶抑制剂 噻唑烷二酮类药物或DPP-IV抑制剂 基础胰岛素+餐时胰岛素 或 每日3次预混胰岛素类似物 基础胰岛素 或 预混胰岛素 胰岛素促分泌剂或 α-糖苷酶抑制剂噻唑烷二酮类药物或DPP-IV抑制剂 GLP-1受体激动剂 一线药物治疗 二线药物治疗 三线药物治疗 四线药物治疗 生 活 方 式 干 预 2型糖尿病：进展性的疾病 Additional factors of type 2 diabetes progression Parameters of car