糖尿病的饮食、运动、口服药课件.ppt

糖尿病的饮食、运动、口服药双胍类适应症和禁忌症适应症：1、肥胖2型糖尿病首选2、1型糖尿病在应用胰岛素的基础上血糖控制不佳波动较大者。禁忌症：1、糖尿病合并急性并发症：2、孕妇和哺乳期3、肝肾功能不全4、充血性心力衰竭、休克等缺氧状态5、急性感染、大手术等应急状态糖尿病的饮食、运动、口服药α-葡萄糖苷酶抑制剂的作用机理双糖酶葡萄糖淀粉酶多糖单糖寡糖或双糖阿卡波糖---伏格列波糖---糖尿病的饮食、运动、口服药α-葡萄糖苷酶抑制剂的副作用 主要副作用为消化道反应，结肠部位未被吸收的碳水化合物经细菌发酵导致腹胀、腹痛、腹泻糖尿病的饮食、运动、口服药ThiazolidinedionespiglitazoneNSHCl.NH3CN.C4H4O4NSSCH3NNOOOOOOOOOOCH3CH3H3CHOCH3rosiglitazonetroglitazone糖尿病的饮食、运动、口服药格列酮类的作用机制(1)高选择性激活PPARγ(peroxisomeproliferatoractivatedreceptorγ,过氧化物酶增殖体激活受体γ)PPAR为一组核转录因子，包括PPAR-α、PPAR-γ、PPARδ。其中PPAR-γ在肝脏、脂肪和肌肉组织中被发现。研究表明它是脂肪细胞分化、脂代谢稳定和胰岛素作用的重要调控子。Neworaltherapiesfortype2DM,SunderMudaliaretal,Annu.Rev.Med.2001*WeightgainisaproblemwithmanycurrentdiabetestreatmentsTheinfluenceofdiabetestreatmentonweightwasevidentintheUKPDSstudy(UKPDS34):regardlessoftreatment,patientsgainedweight.Patientstreatedwithinsulinshowedthelargestweightincrease,withanaveragegainof4.0kgmorethanconventionaltherapyat10years(UKPDS33).TheextentofweightgainobservedinUKPDSininsulin-treatedpatientshasbeenconfirmedinsubsequentstudies.Forexample,ina6-monthstudycomparingbedtimeinsulinglarginewithNPHinsulinoncedaily(bothagentsaddedtoexistingoraltherapyinatreat-to-targetprotocol),weightgainattheendofthetrialperiodwas3.0and2.8kg,respectively(Riddleetal.2003).Generally,weightgainistheconsequenceofanincreaseincalorieintakeoradecreaseincalorieutilisation.Itcanresultfromanumberofspecificfactors:Poorglycaemiccontrolincreasesmetabolicrateandconsequently,improvingglycaemiccontroldecreasesmetabolism.Ifcalorieintakeisnotmodifiedaccordingly,thenweightwillincrease.Improvingmetaboliccontrolreducesglucosuria(excretionofglucosethroughtheurine),thusfewercaloriesarelostinthismanner.Normally,insulinsuppressesfoodi