强化胰岛素治疗在2型糖尿病format.ppt

提 纲 传统疗法足够了吗？ 1 早期胰岛素强化治疗的尝试 2 不同干预方式的比较 3 不同干预方式疗效差异的机制探讨 4 总 结 5 总 结 UKPDS十年随访研究显示：早期强化血糖控制可维持减轻微血管并发症的益处，还显著减少心肌梗塞发生，降低全因死亡 在疾病早期使用短程胰岛素强化干预，可促进Β细胞修复，延缓病程进展；使用胰岛素疗效优于OHA，且不显著增加低血糖及体重增加的风险 强 化 降 糖 血糖良好控制 低血糖 依从性不佳 体重增加 疗效的 争议 比我们现在做到的更早开始胰岛素治疗和胰岛素强化治疗，生活质量不会因胰岛素的使用而受到影响。 致 谢 感谢国家重点基础研究973项目、广东省科技厅 感谢诺和诺徳（中国）制药有限公司和罗氏诊断产品（上海）有限公司对项目的大力支持 感谢胰岛β细胞保护临床研究协作组的各中心所有参与研究的医生、护士、技术员以及参与研究的所有患者 感谢郑以漫博士、加拿大Meng Hee Tan博士、陈维清教授和所有对本项目做出贡献的朋友 学习动物精神 11、机智应变的猴子：工作的流程有时往往是一成不变的，新人的优势在于不了解既有的做法，而能创造出新的创意与点子。一味 地接受工作的交付， 只能学到工作方法 的皮毛，能思考应 变的人，才会学到 方法的精髓。 学习动物精神 12、善解人意的海豚：常常问自己：我是主管该怎么办才能有助于更好的处理事情的方法。在工作上善解人意， 会减轻主管、共 事者的负担，也 让你更具人缘。 Analyses adjusting for insulin sensitivity showed that β-cell function was compromised in IGT, DM2h, DMf, and DM, relative to NGT, by 13, 12, 59, and 62% (HOMA-B) and by as much as 40, 60, 80, and 75%, using AIR. * * Results Between-group differences in glycated hemoglobin levels were lost after the first year. In the sulfonylurea–insulin group, relative reductions in risk persisted at 10 years for any diabetes-related end point (9%, P=0.04) and microvascular disease (24%, P=0.001), and risk reductions for myocardial infarction (15%, P=0.01) and death from any cause (13%, P=0.007) emerged over time, as more events occurred. In the metformin group, significant risk reductions persisted for any diabetes-related end point (21%, P=0.01), myocardial infarction (33%, P=0.005), and death from any cause (27%, P=0.002). Conclusions Despite an early loss of glycemic differences, a continued reduction in microvascular risk and emergent risk reductions for myocardial infarction and death from any cause were observed during 10 years of post-trial follow-up. A continued benefit after metformin therapy was evident among overweight patients. * * RESULTS— After 1 year the glucagon-stimulated C-peptide response was increased in the insulin-treated group by 0.140.08 nmol/l, whereas it was decreased by 0.120.08 nmol/l in the g