2型糖尿病口服降糖药的应用-备案-培训课件.ppt

* 先了解下在未经药物治疗的T2DM中联合方案与单药的比较－－3705研究，这个是研究的设计方案 共433例患者，来自中国17个sites. 入组标准：此类患者特点： 以胰岛素分泌不足为主要特点 血糖异常以餐后血糖升高为主 胰岛β细胞功能较之后为好，是促泌剂使用的最佳人群 A subject must be withdrawn if the following applies: Pregnancy or intention of being pregnant Recurrent and unacceptable hypoglycaemia by the discretion of the Investigator Can’t tolerate the protocol-specified minimal dose which is repaglinide 1mg plus metformin 500mg TID for the combination therapy and repaglinide 1mg TID for the monotherapy, due to severe GI side effects or clinical reasons. Starting a medication which, in the opinion of the investigator, may confound the results of the trial after randomisation. Uncontrolled hyperglycaemia (as guidance, fasting glucose＞15 mmol/L at two consecutive measurements) on the maximal dose of the trial drug(s) 剂量调整的标准： The optimal glycaemic control is defined as fasting and preprandial plasma glucose: FPG　4.4-6.1 mmol/l. * 研究结果显示诺瑞格列奈单药已经能够能好的控制血糖，联合用药组效果进一步加强。 * * * 按ADA/EASD标准(HbA1c7.0%),两组患者达标率为70%以上 以上从理论基础看瑞格列奈联合二甲双胍的优势，我们再看看联合二甲双胍，瑞格列奈与长效SU类格列美脲的头对头的研究 Bratisl Lek Listy. 2009;110(6):335-9. Evaluation of the repaglinide efficiency in comparison to the glimepiride in the type 2 diabetes patients poorly regulated by the metmorfine administration. Dimic D, Velojic Golubovic M, Antic S, Radenkovic S. Source Clinical Center Nis, Clinic ofEndocrinology, Diabetes and Metabolic Disorders, Nis, Serbia. drdragand@bankerinter.net Abstract OBJECTIVES: An impaired early phase of insulin secretion in the type 2 diabetes mellitus (DM) is very important for the postprandial hyperglycemia. The aim of the study was to compare the efficacy of metformin/repaglinid and metformin/glimepirid regimes in type 2 diabetics uncontrolled with metformin monotherapy. METHODS: Totally, 60 type 2 diabetics with haemoglobin A1c or = 7.5% and 2000 mg of metformin monotherapy for at least three months were divided in the following groups: A-30 patients with metformin+repaglinid (2 mg for each meal) and B me