课件：糖尿病及其治疗策略.ppt

* * 到底什么原因导致达标这么困难呢？ * Psychological insulin resistance (PIR) refers to a patient’s reluctance to begin insulin therapy or delaying insulin therapy for long periods of time.1 Patients may either refuse insulin outright or try to bargain with their doctor for more time on their current treatment to avoid insulin.1 This resistance to insulin therapy was demonstrated in the UKPDS, in which 27% of patients with type 2 diabetes who were randomized to receive insulin, initially refused this treatment option.2 The DAWN study (Diabetes Attitudes Wishes and Needs) went on to show that more than half of insulin-na?ve patients were worried about the prospect of taking insulin.3 In a survey undertaken with insulin-na?ve patients with type 2 diabetes, 24.7% or respondents were unwilling to take insulin, if prescribed.4 Patients avoid insulin therapy for several reasons, because of a perceived loss of control, a lack of confidence about handling the demands of insulin therapy, a sense of personal failure, a perception of worsening disease severity, injection-related anxiety and a perceived lack of positive gain from this treatment approach.4 1. Polonsky WH and Jackson RA. What’s so tough about taking insulin? Addressing the problem of psychological insulin resistance in type 2 diabetes. Clin Diabetes 2004;22:147–50. 2. UKPDS 13. Relative efficacy of randomly allocated diet, sulphonylurea, insulin, or metformin in patients with newly diagnosed non-insulin dependent diabetes followed for three years. BMJ 1995;310:83–8. 3. Korytkowski M. When oral agents fail: practical barriers to starting insulin. Int J Obes Relat Metab Disord 2002;26:S18–24. 4. Polonsky WH, et al. Why do patients resist insulin therapy? Diabetes 2003;552:1811P. * * 关于怎样合理用药，中国的指南告诉我们：对于血糖未达标的患者，最终需起始胰岛素治疗，使血糖尽早达标。. * 关于怎样合理用药，中国的指南告诉我们：对于血糖未达标的患者，最终需起始胰岛素治疗，使血糖尽早达标。. * * * * 正常情况下，食物经过胃肠的消化，变成单个的葡萄糖。葡萄糖通过肠道吸收进入血液，使血糖升高。人体把血糖升高的信号传递给胰腺的胰岛?细胞，?细胞就产生了胰岛素，释放到血液中。胰岛素就象一把“钥匙”，在人体内的组织细胞表面有许多专门接受胰岛素的小结构，称为受体，就象一把“锁