2型糖尿病早期的治疗药物选择 ppt课件.pptx

Earlytherapyandregimenchoicefortype2diabetesinWesternpatients,BjrnEliassonSahlgrenskaUniversityhospitalandUniversityofGothenburg,Sweden,1,Goodglucose-loweringtreatment:requirements,Efficacious(glucose-lowering)SafecardiovascularoutcometrialsFewside-effectsweighthypoglycaemiaReasonableprice,2,Experience,scienceandprice,3,CVOT-Cardiovascularoutcometrial,4,Diabetes2009;58:77395.,5,Availableoptions,6,Metformin,7,BMJOpen2012;2:e001076.doi:10.1136/bmjopen-2012-001076,8,9,Sulfonylurea,10,NEnglJMed2008;358:2560-72.,11,NEnglJMed2008;358:2560-72.,CumulativeIncidencesofEvents,AccordingtoGlucose-ControlStrategy,12,SGLT-2inhibitors,13,DOI:10.1056/NEJMoa1504720,14,Cumulativeincidencefunction.MACE,MajorAdverseCardiovascularEvent;HR,hazardratio,3-pointMACE,15,Empagliflozin10mgHR0.85(95%CI0.72,1.01)p=0.0668,Empagliflozin25mgHR0.86(95%CI0.73,1.02)p=0.0865,DPP-4inhibitors,16,tecos,NEnglJMed2015;373:232-42,17,NEnglJMed2015;373:232-42,18,GLP-1receptoragonists,19,AmHeartJ2015;169:631-638.e7,20,(death,AMI,stroke),21,Pioglitazone,22,Lancet2005;366:127989,23,Lancet2005;366:127989,24,Acarbose,25,Dateofdownload:11/1/2015,Copyright2015AmericanMedicalAssociation.Allrightsreserved.,From:AcarboseTreatmentandtheRiskofCardiovascularDiseaseandHypertensioninPatientsWithImpairedGlucoseTolerance:TheSTOP-NIDDMTrial,JAMA.2003;290(4):486-494.doi:10.1001/jama.290.4.486,26,Insulin,27,NEnglJMed2012DOI10.1056/NEJMoa1203858,28,NEnglJMed2012DOI10.1056/NEJMoa1203858,29,Treatmentguidelines,2examplesEuropeandUSASweden,30,31,DiabetesCare2015;38:140149,32,DiabetesCare2015;38:140149,33,2015-02-17,SwedishNationalguidelinesfordiabetescare(3.0,17Feb2015),34,35,(Regionalguideline,WesternSweden),36,Type2diabetestreatmentalgorithminRegionWesternSwedenIndividualisationEarlyandintensivetreatmentMonitorSwitchiffailureorside-effectslifestyle+metforminsecondline=SU/insulinthirdline=therest,(Translation),37,Conclusions,8differentclassesofagentsGlucose-loweringabilitiescomparableVari