《二甲双胍临床应用专家共识》解读PPT课件

主要内容冬共识制订的背景冬共识重点内容解读多数国际指南推荐二甲双胍是2型糖尿病治疗的唯一一线药物Healthy eating,weight control,increased physical activityInitial drugmonotherapyMetforminEfficacy HbA)highHypoglycemialow riskWeightneU右aM0ssSide cffectsGl/lactic acidosisCostslow.peeded to reach lodldduallzed HbA.tamget atter -3 months ptoceed to two-dog combioatloo(order not meanf to denote any specific preference):MetforminMetforminMetforminMetforminMetforminTwo-drugThiazolidine-DPP-4 InhibitorInsulin (usuallycombinationsSulfonylureaGLP-1 receptordioneagonistbasal)Efficacy (HbA.)highhigh.intermediatehighhighestHypoglycemiamoderate risklow risklow risklow riskhigh riskWeightgaingainneutral88gainMajor side effect(s)hypoglycemiaedema.HF.Fx'srareGIhypoglycemiaCostslowhighhighhighvariable(order not meant to denoto any spocific preforenco):MetforminMetforminMetforminMetforminMetforminThree-drugSulfonylureaThiazolidine-DPP-4 InhibitorGLP-1 receptorInsulin (usuallycombinationsdioneagonistbasal)X++TZD,四8管PSUSUSUTZDorDPP-4-iDPP-4-iorTZDorTZDorDPP-4iGLP-1-RAGLP-1-RAInsulinInsulin9GLP-1-RAorInsulinInsulinIf combination therapy that includes basal insulin has failed to achieve HbA.target after 3-6 months,proceed to a more complex insulin strategy,usually in combination with one or two noninsulin agents:L》More complexinsulin strategiesInsulin(multiple daily doses)American Diabetes Association.Diabetes Care,2014,37 Suppl 1:S14-80.2013中国2型糖尿病防治指南二甲双胍为一线首选用药CHINESE DIABETES SOCIETY中甲语学金韩承病等分金主要治疗路径备选治疗路径如血糖控制不达标(A1C≥7.0%)则进入下一步治疗一线药物治疗·二甲双胍为二甲双胍α-糖苷酶抑制剂/胰岛素促泌剂一线首选生活方式干预·取消二/三线的二线药物治疗备选路径胰岛素促泌剂α-糖苷酶抑制剂/二肽基肽酶V抑制剂/噻唑烷二酮类三线药物治疗基础胰岛素/胰岛素促泌剂/α-糖苷酶抑制剂/二肽基肽酶V抑制剂每日1-2次预混胰岛素噻唑烷二酮类/胰高血糖素样肽1受体激动剂四线药物治疗基础胰岛素+餐时胰岛素/基础胰岛素每日3次预混胰岛素类似物每日1-2次预混胰岛素2013年版中国2型糖尿病防治指南