【PPT】糖尿病的胰岛素治疗与低血糖的预防PPT课件 - 医学资源下载
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糖尿病的胰岛素治疗与低血糖的预防PPT课件 胰岛素治疗的适应症 1型DM 2型DM 急性并发症时，如创伤、手术、酮症酸中毒、高渗综合征、感染等 伴发严重的慢性并发症 肝、肾功能严重损害 不能耐受口服降糖药或药物原发失效 口服降糖药疗效减弱，药物继发失效 糖尿病合并妊娠或妊娠糖尿病 其它因素引起的糖尿病，如继发性胰腺疾病、内分泌疾病、伴糖尿病的一些遗传性疾病糖尿病的胰岛素治疗与 低血糖的预防 PPT课件 2型糖尿病中进行胰岛素治疗的新概念 随着病程的进展，胰岛?细胞功能逐年减低 可以通过降低高糖毒性提高胰岛素的敏感性 不增加心血管疾病的死亡率，可以降低一切与糖尿病相关的死亡风险 ADA建议：无论是1型还是2型糖尿病均需严格控制血糖（包括使用胰岛素），使糖尿病患者的血糖水平正常或接近正常糖尿病的胰岛素治疗与 低血糖的预防 PPT课件 Slide 6-15 BARRIERS TO INSULIN THERAPY Reassurance About Common Concerns The preceding slides have presented findings that offer reassurance about the risk-benefit ratio of using insulin for type 2 diabetes. Slide 9 shows that intensive treatment with insulin actually improves the insulin sensitivity of pe**heral tissues, at least in the short term, by reducing the glucotoxic effects of hyperglycemia. Slide 10 shows that insulin treatment improves triglyceride levels, fosters a trend toward better HDL levels, and has no effect on LDL levels or blood pressure. Slide 11 shows an impressively reduced mortality with immediate and sustained intensive insulin treatment following myocardial infarction, suggesting that in this setting the benefits outweigh any theoretical cardiovascular hazards. Slide 12 shows the weight gain found in the UKPDS with various treatments, confirming that insulin causes the most weight gain but also that the mean gain is relatively modest, about 10 lb during 10 years for both less obese and more obese patients. Slide 13 shows that concurrent use of metformin markedly reduces weight gain when insulin treatment is started or intensified. Slide 14 shows more data from the UKPDS confirming that both mild and severe hypoglycemia are more common with insulin treatment than with other treatments, but that the rate of severe hypoglycemia is quite low. Buse JB. Overview of current therapeutic options in type 2 diabetes. Diabetes Care. 1999;22(suppl 3):C65-C70; Berger M, Jorgens V, Mühlhauser I. Rationale for the use of insulin therapy alone as the pharmacological treatment of type 2 diabetes. Diabetes Care. 1999;22(suppl 3):C71-C75; UK Prospective Diabetes Study (UKPDS) Group. Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet. 1998;352:837-853.糖尿病的胰岛素治疗与 低血糖的预防 PPT课件 Slide 6-4 TYPE 2 DIABETES…A PROGRESSIVE DISEASE Progressive Decline of b-Cell Function in the UKPDS In 1996, results of 6 years of follow-up of the patients in the UK Prospective Diabetes Study were reported. Although the patients who received intensive treatment maintained significantly better glycemic control, all groups showed progressive hyperglycemia over the 6 years, with associated decrease in b-cell function. b-Cell function deteriorated in the patients who were allocated to and remained on diet therapy, with a significant decrease from 1 to 6 years (53% to 26%; P < .0001). Those on sulfonylurea therapy displayed an increase in b-cell function during the first year of therapy (46% to 78%) that subsequently decreased significantly to 52% (P < .0001) by year 6. Patients who were allocated to metformin therapy also had an increase in b-cell function in the first year that deteriorated at 6 years (66% to 38%), which was similar to that seen in the patients treated with diet alone. UK Prospective Diabetes Study Group. UK Prospective Diabetes Study 16: Overview of 6 years’ therapy of type II diabetes: A progressive disease. Diabetes. 1995;44:1249-1258.糖尿病的胰岛素治疗与 低血糖的预防 PPT课件

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