《ada easd专家共识》PPT课件.ppt

* 生活方式干预，除了长期坚持存在困难外，也会带来一些不良作用，例如小的骨骼肌损伤，与神经病变相关的问题如足部溃疡等，也会随着运动量的增加而恶化 the consensus is that lifestyle interventions should be initiated as the first step in treating new-onset type 2 diabetes (Fig. 2). These interventions should be implemented－－－操作困难，需要经过专业训练的营养师和行为调整专家，与种族和环境有关 by health care professionals with appropriate training, usually registered dietitians with training in behavioral modification, and be sensitive to ethnic and cultural differences among populations. Moreover, lifestyle interventions to improve glucose, blood pressure, and lipids levels and to promote weight loss or at least avoid weight gain should remain an－－－生活方式干预有很多好处，应该作为2型糖尿病管理中的一项基本措施 underlying theme throughout the management of type 2 diabetes, even after medications are used. For the 10–20% of－－－而不胖的病人通常需要尽早药物治疗 patients with type 2 diabetes who are not obese or overweight, modification of dietary composition and activity levels may play a supporting role, but medications are generally required earlier * 2型糖尿病是一个进展性的疾病，在进展过程中，β细胞功能逐渐下降。口服药物的作用，例如磺脲类的作用，依赖于残存的β细胞功能。因此，当β细胞功能下降时，需要联合治疗（例如，在SU的基础上增加胰岛素）以维持良好的血糖控制。 * * * 参考7，27，42－44 * 对于有的治疗的降血糖外的其它作用，如针对心血管疾病危险因素高血压、脂代谢紊乱等的作用，也是很重要的。 这个共识里，也比较了在血糖控制的长期过程中，不同的干预措施对某些方面带来的改善或恶化的影响，这些方面包括体重指数、胰岛素抵抗或胰岛素分泌能力。 * ？ * 二甲双胍对血糖和血脂的作用：荟萃分析的数据 这些数据来源于对41个研究的荟萃分析，这些病人使用二甲双胍治疗6周，收集了血糖、血脂和/或血压的数据。二甲双胍治疗与显著的HbA1C 、甘油三酯、总胆固醇和LDL胆固醇水平下降相关，HDL胆固醇不受影响。 二甲双胍对收缩期血压（平均改变为-1.09 mmHg [95% CI -3.01 － 0.82] ）和舒张期血压（平均改变-0.97 [95% CI -2.15 to -0.21])没有影响。 Effects of metformin on glycaemia and lipids: data from a meta-analysis These data are from a meta-analysis of 41 studies of at least 6 weeks’ duration providing data on glycaemia, lipids and/or blood pressure in patients treated with metformin. Metformin treatment was associated with significant reductions in HbA1C, triglycerides, total cholesterol and LDL-cholesterol. HDL-cholesterol was unaffected. Metformin also did not affect systolic blood pressure (mean change -1.09 mmHg [95% CI -3.01 to 0.8