CDS-胰岛素方案1型糖尿病胰岛素治疗方略.pptVIP

首都医科大学附属北京儿童医院 巩纯秀;内 容;糖尿病治疗的目的;医疗目的: 控制血糖，延缓并减少并发症;正常人 糖尿病病人 区别; 灵活有效治疗 方便舒适 少痛苦;ISPAD指南2009指出;胰岛素治疗;五驾马车;预混还是餐时-基础？？;胰岛素治疗;胰岛素方案——胰岛素、运动、进食相匹配;基础-餐时;;胰岛素临床应用方案调查;不同国家胰岛素方案调查结果（电话）;;在患病后数年，不同的治疗???法获得良好治疗的比例;预混胰岛素使用情况调查;2009ISPAD指南;There is no clear evidence that pre-mixed insulins in young children are less effective, but some evidence of poorer metabolic control when used in adolescents (#).;;;原因复杂;病程一年以上者显示多次预混或笔注射效果好;;有关预混型胰岛素文献少， 多在2007前。临床实际效果不佳;不同组分双时相胰岛素降糖比较（6月）;花费调查 ;花费;CSII使用情况;;The National Institute for Health and Clinical Excellence recommends CSII from diagnosis of type 1 diabetes for patients 12 years and for those 12 years with inadequate glycaemic control on MDI or disabling hypoglycaemia. However, the authors of this guideline recognise that the evidence supporting their recommendations is poor. The additional cost of insulin pump therapy is estimated to be ￡1700 (€1950; $2770) per annum. At present there is little robust evidence that this additional investment significantly improves glycaemic control, reduces the prevalence of long term complications, or improves quality of life in the paediatric population. 指南并不是绝对的，认识过程;糖尿病控制状况总体趋势;;反思：;询证与实效研究方法学的启示;不同研究方法的差异特点;胰岛素治疗方案应用调查启示？？; 糖尿病病人 需要 正常生活;;教育到位——鼓励病人参与选择方案;胰岛素治疗方案、剂量及调节;小结;谢 谢