肾功能不全对口服降糖药应用安全性的影响.pptVIP

维格列汀 GFR ≥ 50，无需调整剂量 GFR 50，禁用 利格列汀 GFR ≥ 15，无需调整剂量 GFR 15，慎用(用药经验有限) 中国专家共识 DPP-4抑制剂在慢性肾脏病患者的应用 西格列汀 GFR ≥50，无需调整剂量 GFR 30-49，剂量降至50mg/日 GFR 30 ，剂量降至25mg/日(证据有限，谨慎使用) 沙格列汀 GFR ≥ 50，无需调整剂量 GFR 30-50，剂量减半 GFR 30，禁用 GFR单位： mL/min/1.73m2 当前第28页\共有28页\编于星期四\21点 * * 目前，2型糖尿病治疗可选择的药物越来越多。不管是单药还是联合用药，都应认真参照药品说明书。除此之外，还应考虑到与患者有关的方面如降糖疗效，伴随疾病和并发症，发生副反应的风险，患者耐受性及药物花费等等。 * 各国指南包括ADA/EASD必威体育精装版共识，AACE指南，NICE指南以及中国的2型糖尿病防治指南均推荐二甲双胍作为T2DM的一线治疗用药。 * UKPDS研究证实，二甲双胍明显降低了超重或肥胖的T2DM患者的糖尿病相关终点事件和糖尿病相关死亡，并且二甲双胍治疗均能有效降低大血管并发症（心梗，中风）和微血管并发症的发生风险。 * 二甲双胍作为2型糖尿病治疗的一线用药，但是在某些情况下的使用是受限的，如在肾功能受损的T2DM患者，AACE/ACE指南即禁止二甲双胍用于GFR60ml/min/1.73m2 的患者，ADA/EASD/加拿大和澳大利亚指南则放宽了些，二甲双胍禁用于GFR30ml/min/1.73m2 的T2DM，在GFR60时应慎用。 * Clin Ther. 2009 Nov;31(11):2608-17. Antidiabetic medication use and prevalence of chronic kidney disease among patients with type 2 diabetes mellitus in the United States. Koro CE, Lee BH, Bowlin SJ. Abstract OBJECTIVES: The aims of this study were to estimate the proportion of patients with type 2 diabetes mellitus (DM) in the United States with different stages of chronic kidney disease (CKD) and to describe glycemic control and antidiabetic drug use among them. METHODS: Using data from the Fourth National Health and Nutrition Examination Survey (NHANES IV) for the years 1999 through 2004, we performed a cross-sectional analysis of patients with type 2 DM aged or=20 years at the time of the survey interview. CKD stages were categorized according to the classification system established by the National Kidney Foundation Kidney Disease Outcomes Quality Initiative. Anti-diabetic medication use among these patients was described using self-reported survey responses as well as survey medication files. RESULTS: A total of 1462 patients with type 2 DM were included in the analysis. Men and women constituted 48.3% and 51.7% of the study sample, respectively; 15.6% received a DM diagnosis 2 years ago, and 36.2% received their diagnosis 10 years ago. CKD was present in