糖尿病李光伟—培训课件.ppt

* * * Indeed, we have some evidence now that rosiglitazone may actually have some potential protective action on the liver. This was a short monotherapy study performed using MRI spectroscopy by Dr David Carey in Brisbane, Australia, which shows that when rosiglitazone was given to type 2 diabetic patients at a dose of 4 mg twice daily, it caused a substantial fall in the liver fat/water signal. Since hepatic steatosis is frequently found in obese subjects with or without type 2 diabetes, and since hepatic steatosis may progress to non-alcoholic steatohepatitis and even cirrhosis and liver failure, this ability of rosiglitazone to lower the liver fat content may suggest a potential future use in treating fatty liver disease. * 罗格列酮长期增加 HDL-胆固醇水平 100周研究期间HDL-C持续升高。平均HDL-胆固醇持续升高 (100周时与基线相比增加20.2%)。第100周时HDL-胆固醇与基线相比增加9.10 mg/dl。 HDL-胆固醇mg/dl 换算成 mmol/l的换算系数 = x 0.0259。 GlaxoSmithKline. Data on file. * * * 40 The early, aggressive approach to type 2 diabetes management avoids the risk of early treatment failure by adopting an intensive therapeutic strategy immediately upon diagnosis. Combinations of agents with complementary modes of action targeting the dual defects underlying type 2 diabetes (insulin resistance and ?-cell dysfunction) are most likely to support tight, long-term glycemic control. Furthermore, combination therapy with OADs (oral anti-diabetics), should be considered earlier in the regimen to provide additional glycemic control. Campbell IW. Br J Cardiol 2000; 7:625–631. * * 罗格列酮主要作用是增加外周组织，也就是说，脂肪和肌肉组织的胰岛素敏感性，其继发效应是降低肝糖原输出。1,2 噻唑烷二酮类药物（TZDs）也改善 ?-细胞功能，无论是其对?-细胞的直接作用或者是其潜在的胰岛素增敏作用的间接结果。.3 二甲双胍主要通过减少肝脏外源性葡萄糖产生而达到降低血糖水平的作用1,4 二甲双胍治疗同样也能适当改善外周胰岛素抵抗。例如，一项研究发现，二甲双胍升高外周葡萄糖处置指数达13%，噻唑烷二酮类则增加54% .1 另一项研究发现，罗格列酮，可改善整体胰岛素敏感性和骨骼肌葡萄糖摄取，而二甲双胍没有这种作用。.5 Hence, 因此，尽管UKPDS研究发现二甲双胍可显著降低大血管并发症，可能与其适度的胰岛素增敏作用有关,6但一种较弱的胰岛素增敏剂（二甲双胍）和一种真正的胰岛素增敏剂（罗格列酮）联用，可获得额外的益处。 1. Inzucchi SE, et al. N Engl J Med 1998; 338:867–872. 2. Miyazaki Y, et al. Diabetologia 2001; 44:2210–