AACE积极调整剂量安全达标-科室会ppt课件

1、AACE启示：积极调整剂量 平安达标AACE引领全球内分泌领域开展 始于1991年，由全球一流的临床内分泌学指点者创建，现已覆86个国家和地域，吸引全世界最好的临床内分泌医师成为会员 自建立之初制定并发布了内分泌领域众多疾病指南，指点全球内分泌疾病的规范化治疗，引领全球内分泌领域最新潮的治疗理念 协会获得了飞速开展，某种程度上使得美国内科学成果在世界上占有领先位置AACE制定众多内分泌疾病的临床专科指南1.Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Supp

2、ort of the Bariatric Patient - 2019 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery 2019 2.Clinical Practice Guidelines for Hypothyroidism in Adults: Cosponsored by the American Association of C

3、linical Endocrinologists and the American Thyroid Association. 2019 3.American Association of Clinical Endocrinologists Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis 2019 4.AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Menopause 2019 5.Ame

4、rican Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly - 2019 6.Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Association and American Association of Clinical Endocrinol

5、ogists - 2019 7.American Association of Clinical Endocrinologists Medical Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan - 2019 8.American Association of Clinical Endocrinologists Guidelines for Clinical Practice for the Diagnosis and Treatment of Postmenopausal Osteoporosis 2

6、019 9.American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules 2019 10. American Association of Clinical Endocrinologists Protocol for Standardiz

7、ed Production of Clinical Practice Guidelines - 2019 Update 11. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Growth Hormone Use in Growth Hormone-deficient Adults and Transition Patients 2021 Update 12. American Association of Clinical Endocrinologis

8、ts and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas 2021 13. American Association Of Clinical Endocrinologists, The Obesity Society, and American Society For Metabolic & Bariatric Surgery Medical Guidelines For Clinical Practice For T

9、he Perioperative Nutritional, Metabolic, And Non Surgical Support Of The Bariatric Surgery Patient 2019 14. AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Hypertension 2019 15. AACE Medical Guidelines for the Clinical Use of Dietary Supplements and Nutraceuticals 2019 1

10、6. AACE Medical Guidelines for the Clinical Practice for Evaluation and Treatment of Male Sexual Dysfunction: A Couples Problem- 2019 Update 17. AACE Medical Guidelines for Clinical Practice for Evaluation and Treatment of Hypogonadism in Adult Male Patients- 2019 Update 18. AACE Medical Guidelines

11、for Clinical Practice for Evaluation and Treatment of Hyperthyroidism and Hypothyroidism 2019 19. AACE/AAES Medical/Surgical Guidelines for Clinical Practice for Management of Thyroid Carcinoma 2019 20. AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Hyperandrogenic Diso

12、rders 2019 httpsaace/publications/guidelines更被专科医师所推崇美国第22届AACE年会于2019年5月1日5日在凤凰城召开备受瞩目的在会议期间盛大公布Garber AJ, et al. Endocr Pract. 2019 Mar-Apr;19(2):327-36.考来维仑考来维仑糖苷酶抑制剂糖苷酶抑制剂胰岛素胰岛素其他药物其他药物= 较少的不良事件较少的不良事件 或能够获益或能够获益单药治疗单药治疗*就诊时就诊时 A1c 9.0%无病症无病症有病症有病症疾病的进展疾病的进展* 所列药物顺序为用药引荐等级次序* * 基于临床3期实验的数据图例二甲双胍

13、GLP-1 受体激动剂DPP4-抑制剂糖苷酶抑制剂SGLT-2 *TZDSU/GLN假设治疗3个月后A1c6.5%，加用第二种药物两药结合治疗两药结合治疗*GLP-1 受体激动剂假设假设3个月未能达标，个月未能达标，那么胰岛素强化治疗那么胰岛素强化治疗三药结合治疗*血糖控制流程图血糖控制流程图生活方式干涉生活方式干涉(包括医疗干涉减轻体重包括医疗干涉减轻体重)DPP4-抑制剂抑制剂TZD* SGLT-2根底胰岛素根底胰岛素二甲双胍二甲双胍或其他或其他一线药物一线药物SU/GLN快速释放型溴隐亭快速释放型溴隐亭假设假设3个月后个月后仍未能达标，仍未能达标，那么三药结合治疗那么三药结合治疗二甲双胍

14、二甲双胍或其他或其他一线药物一线药物考来维仑考来维仑糖苷酶抑制糖苷酶抑制GLP-1 受体激动剂TZD* SGLT-2根底胰岛素根底胰岛素快速释放型溴隐亭快速释放型溴隐亭二线药物二线药物DPP4-抑制剂抑制剂SU/GLN两药结合治疗两药结合治疗三药结合治疗三药结合治疗 或或加药或胰岛素强化治疗加药或胰岛素强化治疗= 谨慎运用谨慎运用糖尿病药物平安性整体评价一览表Garber AJ, et al. Endocr Pract. 2019 Mar-Apr;19(2):327-36.考来维仑考来维仑糖苷酶抑制剂糖苷酶抑制剂胰岛素胰岛素其他药物其他药物= 较少的不良事件较少的不良事件 或能够获益或能够获益

15、单药治疗单药治疗*就诊时就诊时 A1c 9.0%无病症无病症有病症有病症疾病的进展疾病的进展* 所列药物顺序为用药引荐等级次序* * 基于临床3期实验的数据图例二甲双胍GLP-1 受体激动剂DPP4-抑制剂糖苷酶抑制剂SGLT-2 *TZDSU/GLN假设治疗3个月后A1c6.5%，加用第二种药物两药结合治疗两药结合治疗*GLP-1 受体激动剂假设假设3个月未能达标，个月未能达标，那么胰岛素强化治疗那么胰岛素强化治疗三药结合治疗*生活方式干涉生活方式干涉(包括医疗干涉减轻体重包括医疗干涉减轻体重)DPP4-抑制剂抑制剂TZD* SGLT-2根底胰岛素根底胰岛素二甲双胍二甲双胍或其他或其他一线药

16、物一线药物SU/GLN快速释放型溴隐亭快速释放型溴隐亭假设假设3个月后个月后仍未能达标，仍未能达标，那么三药结合治疗那么三药结合治疗二甲双胍二甲双胍或其他或其他一线药物一线药物考来维仑考来维仑糖苷酶抑制糖苷酶抑制GLP-1 受体激动剂TZD* SGLT-2根底胰岛素根底胰岛素快速释放型溴隐亭快速释放型溴隐亭二线药物二线药物DPP4-抑制剂抑制剂SU/GLN两药结合治疗两药结合治疗三药结合治疗三药结合治疗 或或加药或胰岛素强化治疗加药或胰岛素强化治疗= 谨慎运用谨慎运用根底胰岛素：具备较好的平安性根底胰岛素：具备较好的平安性 备受专业指南推崇备受专业指南推崇“根底胰岛素根底胰岛素两联及三联治疗方

17、案中作为两联及三联治疗方案中作为 独一引荐独一引荐 假设假设A1c9%明确引荐作为起始胰岛素方案明确引荐作为起始胰岛素方案启示：启示： 积极调整剂量积极调整剂量 平安达标平安达标目的兼顾疗效及平安性目的兼顾疗效及平安性剂量调整是达标的剂量调整是达标的“关键一步关键一步方法简单、适用性强方法简单、适用性强分层设定血糖管理目的目的问题目的问题*对于无合并症及低血糖风险小的患者*伴合并症及有低血糖风险的患者指南指南HbA1c水平水平空腹及餐前空腹及餐前BG水平水平安全性目标安全性目标中国2型糖尿病防治指南2019年版7%3.9-7.2 mmol/L无明显低血糖ADA/EASD 糖尿病诊疗指南2019

18、年版7%7.2 mmol/L且无明显低血糖AACE 糖尿病临床路径2019年版6.5%*6.5%*6.1 mmol/L且无低血糖发生Inzucchi SE, et al. Diabetes Care. 2019 Jun;35(6):4-79.Garber AJ, et al. Endocr Pract. 2019 Mar-Apr;19(2):327-36.中国糖尿病控制现状不容乐观亚洲糖尿病管理中国协作组在2019至2019年调查了中国华北、华南、华东、华西和东北5大地域的49家市级中心医院的2248例糖尿病患者，结果显示：仅1/4患者A1C控制理想，45%的患者A1C7.5%潘长玉等, 中华内分泌代谢杂志, 2019, 5 :420-424.患者比例%HbA1c程度(根据APDPC治疗指南分层)患者离目的终究有多远？真的遥不可及吗？患者离目的终究有多远？真的遥不可及吗？固定调整方案固定调整方案根据根据FPG调整方案调整方案基础胰岛素起始治疗TDD增加2U FBG10mmol/L：增加4U FBG 7.8-10mmol/L：增加2U FBG 6.1-7.7mmol/L：增加1U如发生低血糖，TDD： BG3.9mmol/L：减少10%20% BG2.2mmol/L：减少20%40%强化治疗（餐时控制）TDD增加2U FBG10mmol/L：增加4U