2型糖尿病的治疗案例.ppt

Antihyperglycemic therapies of type 2 diabetes Su xin The second Xiangya Hospital of Central South University Contents Impact of type 2 diabetes New concepts in understanding the pathophysiology of T2DM Current therapies and unmet needs Emerging therapies Treatment algorithms What is happened? How Severe are the Secondary Complications of Diabetes Most common cause of blindness Most common cause of kidney disease needing dialysis Most common cause of non-traumatic amputations Stroke and heart disease are 2-4 times more common in diabetic patients Major cause of neural pain and erectile dysfunction Congenital malformations 4 times as common in diabetic pregnancies Death Rates From Diabetes Continue to Rise, Yet….. What do we want to do? Today, treatment goals are aimed at preventing, delaying, slowing down, or stopping long-term complications that constitute the major burden of diabetes For years, the HbA1c test has been considered the gold standard for assessing glycemic status in patients with diabetes Numerous prospective and epidemiologic studies have featured improved glucose control as measured by HbA1c as an endpoint HbA1c Should be Targets Individualized What can we do? 口服降糖药的种类 磺脲类降糖药 第一代： 苯磺丁脲 氯磺丙脲 非磺脲类促泌剂 瑞格列奈 ：诺和龙 孚来迪 那格列奈 ：唐力 生理状态下葡萄糖刺激胰岛素释放的模式 促泌剂作用机制 磺脲类药物作用强弱比较 效力由 强到弱 主要特点及用法 促泌剂的不良反应 低血糖反应 双 胍 类 药 物 苯乙双胍（降糖灵）： 价廉；易产生严重的乳酸酸中毒；国外已禁用；对肝、肾功能不好者和年老体衰者应禁用 噻唑烷二酮类 罗格列酮——文迪雅 太罗 爱能 吡格列酮——瑞彤 卡司平 噻唑烷二酮类药物作用机制 选择性激活PPARγ（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、PPAR-δ 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。 促进葡萄糖的摄取 促进外周组织胰岛素引起GLUT1，GLUT4介导的葡萄糖摄取 噻唑烷二酮类药物的作用机制 噻唑烷二酮类药物的不良反应 α-葡糖苷酶抑制剂的种类 α-葡糖苷酶抑制剂的作用机制 amylin analogue (Pramlintide) amylin is a small peptide hormone that is released into the bloodstream by the β-cells of the pancreas along with insulin, after a meal.[2] Like insulin, amylin is deficient in individuals with diabetes. B