糖尿病教育权威英文3_1 Blood glucose-lowering medicines.ppt

Pharmacological managementBlood glucose-lowering medicines Section 3 | Part 1 of 3 Curriculum Module III-2 | Glucose-lowering medication Aims of treatment Reduce the symptoms of hyperglycaemia Limit adverse effects of treatment Maintain quality of life and psychological well-being Prevent or delay vascular complications of diabetes UKPDS: long-term glucose control Natural history of type 2 diabetes Understanding the names Chemical name relates to chemical structure Generic name identifies a unique compound with therapeutic properties Brand name given by the manufacturer What are the most common oral blood glucose-lowering medicines in your community? What are their brand names and generic names? The principles of combination therapy  Two (or more) oral blood glucose-lowering medicines that have different mechanisms of action Two medications rather than increase in initial medicine to maximum dosage Fewer side effects than mono-therapy at higher doses Expected effect of blood glucose-lowering medicines Strategies to help people remember Check that people understand how and when to take their medicines Clarify the benefits of treatment Keep regimens simple Minimize costs Discuss adverse effects Suggested starting medicine Increasing or adding If goals have not been reached within 2-3 months, medication should be increased or medication from a different class added Target levels should be reached within 6 months Insulin should be added if necessary to reach target levels Biguanides Action not fully understood Decreases glucose production in liver Mild and variable effect on muscle sensitivity to insulin Side effects Gastrointestinal (nausea, abdominal discomfort or diarrhea and occasional constipation) Lactic acidosis Biguanides Contraindications Renal insufficiency Liver failure Heart failure Severe gastrointestinal disease Advantages Do not cause hypoglycaemia when used as mono-therapy Do not cause weight gain; may contribute to weight loss Biguanides Fi