中国新诊断型糖病初始治疗方案的探讨 ppt课件.ppt

小结（2） 经48周治疗后， 两组达标率（HbA1c 7%）均超过78% 降低空腹血糖：二甲双胍优于阿卡波糖 降低餐后2h血糖：阿卡波糖优于二甲双胍 阿卡波糖降低空腹血糖达1.46 mmol/L，降低餐后血糖达3.08 mmol/L 阿卡波糖降低餐后胰岛素水平优于二甲双胍 阿卡波糖减轻体重及降低甘油三酯优于二甲双胍 阿卡波糖指南地位：一线起始，全程推荐 2012 IDF指南 2010 中国指南 * Thank you very 解放军总医院陆菊明教授介绍了在9872例患者中进行的多中心、非干预性中国2型糖尿病口服药物治疗模式的调查研究（China?DiaSTAGE）结果。 　　结果显示，二甲双胍应 用率居首（53.7%），其他药物应用率由高至低依次为磺酰脲类（42.7%）、糖苷酶抑制剂（39.5%）、格列奈类（27.5%）。降糖药物单用比例 为35.8%；两种药物联用率为45.4%，二甲双胍与磺脲类药物联用情况最为多见。32%的治疗方案在1年内被改变，主要缘于疗效较差。 HbA1c≤6.5%及HbA1c7.0%比例分别为28.0%和40%。近一个月的低血糖发生率为14%，体重升高者为8%。EQ-5D量表评 分总体较好。 * 这是欧美的指南情况，中国患者特点不同，AGI应用广泛，列为一线备选；不仅如此，阿卡波糖在其他亚洲国家包括印度，日本等也被医生患者广泛认可，因此IDF全球指南中也将AGI列为一线备选地位。 * 2型糖尿病的过程是渐进的，通常在病程的起始先表现为餐后血糖升高，逐渐出现空腹血糖也升高。 * 在这项研究中，将130例2型糖尿病患者按HbA1C水平分成5组，用24小时动态血糖监测观察其血糖谱的不同。发现在糖化水平较低的时候，患者首先表现为餐后血糖升高，随着糖化水平的升高，黎明时期血糖逐渐升高；最后，变成持续性高血糖，即夜间空腹血糖也升高。 OBJECTIVE: The aim of the study was to determine whether the loss of fasting and postprandial glycemic control occurs in parallel or sequentially in the evolution of type 2 diabetes. RESEARCH DESIGN AND METHODS: In 130 type 2 diabetic patients, 24-h glucose profiles were obtained using a continuous glucose monitoring system. The individuals with type 2 diabetes were divided into five groups according to A1C levels: 1 (6.5%, n = 30), 2 (6.5-6.9%, n = 17), 3 (7-7.9%, n = 32), 4 (8-8.9%, n = 25), and 5 ( or =9%, n = 26). The glucose profiles between the groups were compared. The overall glucose concentrations for the diurnal, nocturnal, and morning periods, which represent the postprandial, fasting, and the dawn phenomenon states, respectively, were also compared. RESULTS: Glucose concentrations increased steadily from group 1 to 5 in a stepwise manner. The initial differences in mean glucose concentrations reaching statistical significance occurred 1) between groups 1 and 2 (6.4 vs. 7.7 mmol/l, P = 0.0004) for daytime postprandial periods, followed by differences; 2) between groups 2 and 3 (7.5 vs. 9.3 mmol/l, P = 0.0003) for the morning periods (dawn phenomenon); and finally 3) between