,特征表现为:?β细胞功能下降?血糖控制恶化?微血管并发症?,医生、患者将面临着:?低血糖风险增加?体重增加?复杂的治疗方案?%–upperlimitofnormalrangeMedianHbA1c(%)Conventional*<%?(years)023451ADOPTMetforminGlibenclamideRosiglitazone*Dietinitiallythensulphonylureas,insulinand/ormetforminifFPG>15mmol/L;?,n=:352:854–65;al(ADOPT).NEJM2006;355(23):2427–43Glibenclamide(n=277)YearsfromrandomisationInsulin(n=409)Metformin(n=342)Conventionaltreatment(n=411);dietinitiallythensulphonylureas,insulinand/ormetforminifFPG>15mmol/LUKPDS:upto8kgin12yearsADOPT:(kg)Rosiglitazone,()Metformin,-(--)**Glibenclamide,-(-)**Changeinweight(kg):352:854–=atbaseline;al(ADOPT).NEJM2006;355(23):2427–43p<**(%)1039051015202530354045RosiglitazoneMetforminGlibenclamide12Hypoglycaemia,events/patient/year*051020GlargineNPH*;26:3080;al(ADOPT).NEJM2006;355:2427–43大脑胰岛素分泌(葡萄糖依赖)胰高血糖素分泌胰岛素合成细胞量胰腺肝脏肝糖输出能量摄取胃肠道减少动力SlideNo7与人类GLP-1的氨基酸有97%同源与人类GLP-1的氨基酸有53%同源Studyduration:Liraglutide26weeks;,2,3,4,5meta-analysisofantibodyformation;Dataonfile;;28:1092人类GLP-1LiraglutideExenatide患者使用后抗体增加的比例Liraglutide1020406080100Exenatide+metformin243%%?;29:;70:579-588对照2型糖尿病~85%
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