诺和平基础胰岛素的理想选择2.ppt

地特胰岛素良好的血糖控制是否是以牺牲低血糖为代价的呢？我们知道，严格的血糖控制会增加低血糖的风险；如果不能很好地控制血糖，又将增加糖尿病患者的并发症。因此，既能控制患者的血糖，同时又能减少患者低血糖的并发症，是临床医生需要解决的问题。 As previously noted, the risk of hypoglycaemia and fear of it impacts on the level of glycaemic control that patients can aim for, and hence affects their prognosis. DCCT (and UKPDS) showed an inverse relationship between glycated haemoglobin (HbA1c) and risk of hypoglycaemia. * 诺和平可以全面平稳降糖，首先诺和平可以减少胰岛素作用的变异性，进而减少血糖波动，最终减少低血糖事件。 * 接下来我们看一个关于地特胰岛素血糖变异性的研究，这是一个随机对照重复多次的葡萄糖钳夹试验，用以比较诺和平、NPH及甘精胰岛素的变异性，每位患者要重复四次相同剂量的钳夹试验以比较胰岛素作用的个体内变异性。 * 通过公式来对变异系数进行计算之后显示，无论是0-12小时还是0-24小时内的变异系数诺和平均低于甘精胰岛素和NPH胰岛素，且具有统计学差异，提示地特胰岛素的个体内变异性小于甘精胰岛素和NPH胰岛素。 * 从众多的评估了空腹血糖变异性的研究中可以看出，地特胰岛素的血糖变异性显著的小于NPH胰岛素，另外，值得注意的是1型糖尿病患者的血糖变异性均高于2型糖尿病患者，这也反映了内源性胰岛素分泌功能对于外源性胰岛素变异性的缓冲作用。 And in nearly every case where the variability of FBG has been measured in terms of SD, there has been a significant advantage for IDet. In the one study where there was no significant difference in this parameter, there was a significant difference in pre-dinner BG variability. This study was atypical as it employed a treat-to-target protocol adding IDet or NPH as an insulin supplement to OADs in poorly controlled type 2 diabetes. It is noteworthy that variability is in any case consistently lower in the type 2 diabetes trials. Speculatively, this might reflect the ability of endogenous insulin secretion to buffer the variable BG lowering action of exogenous insulin. * 临床研究也显示地特胰岛素更加严格的血糖控制目标并没有增加低血糖风险，无论全部低血糖还是夜间低血糖在两组之间没有统计学差异。 Rates of Overall and Nocturnal Hypoglycemia: Safety Analysis The overall rates of hypoglycemia episodes were low and comparable between target groups Nearly all hypoglycemic events were considered minor or symptoms only. A single major hypoglycemic event was reported by a subject in the 3.9-5.0 mmol/L target group * 如果我们对地特胰岛素的全部3期临床研究进行总体分析，可以发现在绝大部分研究中地特胰岛素的全部低血糖风险小于NPH。 If we now look at an overview for the entire phase 3 trials programme, we again see that a redu