从CDS指南变迁看预混胰岛素在中国2型糖尿病的治疗地位

中华医学会糖尿病学分会(CDS)于2004年制定了第一版《中国2型糖尿病防治指南》,并于2007年、2010年和2013年对指南进行了修订和补充。本文从各指南中关于胰岛素治疗策略的修订,对胰岛素治疗理念的变化进行综述,并阐述预混胰岛素在中国2型糖尿病的治疗地位。     

国产原研药消渴丸入选2010版《中国2型糖尿病防治指南》

<正>2011年10月16日,中华医学会在北京举办的"2010版《中国2型糖尿病防治指南》新闻发布会"上宣布,包括广药集团广州中一药业的消渴丸在内的一批治疗糖尿病药物,经过专家审核甄选,入选《中国2型糖尿病防治指南》。据了解,这是国内原研民族药物首次进入《中国2型糖尿病防治指南》,打破了防治指南药物被化学生物制药一统天下的局面,也是出现在该指南的唯一一个非化学名称的药物。     

基层医院糖尿病防治指南知识水平的调查及培训研究

目的:了解基层医院护士对2007中国糖尿病防治指南知识掌握情况.方法:对本市城区4家二级医院158名护士培训前、后发放2007中国糖尿病防治指南知识问卷调查表.结果:本市城区4家二级医院护士对2007中国糖尿病防治指南知识知晓率低,经过培训,理论明显提高.结论:本市医院护理人员对2007中国糖尿病指南知识掌握不全面,应加强新知识和理论的培训.     

北京地区2007～2011年老年糖尿病患者处方用药调查

目的:了解北京市老年糖尿病患者门诊处方用药的现状及用药趋势,为促进临床合理用药和制定卫生政策提供科学依据。方法:选取北京市有代表性的综合医院22家,调查2007～2011年老年糖尿病患者的门诊处方用药情况,采用最新版的中国糖尿病治疗指南,利用Foxpro6.0数据库操作系统,进行统计分析和评价。结果:北京市2007～2011年门诊老年糖尿患者处方数占总体糖尿病患者处方数的62.93%～65.74%;使用频次前三位的口服降糖药是阿卡波糖、二甲双胍和格列喹酮;使用频次始终排在第4位的是注射用降糖药低精蛋白锌胰岛素。联合用药中,多数是5种以内的药物联合使用;老年糖尿病患者处方平均用药品种数2.86～3.41种;使用频次排在前10位药物品种涵盖了降血压、降血脂、防治心绞痛和抗凝的药物;平均处方费用由2007年的419.33元上升到2011年的555.04元。结论:北京市老年糖尿病患者用药遵循治疗中国糖尿病治疗指南,临床医生治疗糖尿病选择用药品种趋于规范化、合理化。     

早期、短期的胰岛素强化治疗可使2型糖尿病患者长期获益

胰岛B细胞功能进行性衰竭是2型糖尿病发病和疾病进展的决定性因素。最新的《内科学》（第7版）首次将“B细胞明显衰退者”作为胰岛素治疗指征写入教科书。2007年《中国2型糖尿病防治指南》建议,非超重患者在口服降糖药物治疗3个月后效果不佳即推荐加用胰岛素治疗。     

二甲双胍的药物基因组学研究进展

近年来,有关2型糖尿病的诊疗指南不断更新,药物治疗策略日趋个体化。《中国2型糖尿病防治指南（2017版）》于2018年1月正式发布。新版指南进一步突出了二甲双胍在降糖治疗路径中的基石地位。然而,大量的临床研究结果表明：作为首选降糖药物,二甲双胍存在着显著的药物反应个体差异性。究其主因,学者多归转于遗传因素。相关研究绝大部分关注在药物靶蛋白、药物代谢酶、药物转运体蛋白的基因组学方面。因此,为丰富人们对二甲双胍药物反应个体差异性的认识,本文拟从药物基因组学的角度来综述二甲双胍的研究进展。     

“第四届全国药物治疗学学术年会——糖尿病治疗进展和药物临床应用”之集锦

“第四届全国药物治疗学学术年会——糖尿病治疗进展和药物临床应用”于2010—03—27在复旦大学附属中山医院召开。临床专家分别关于2007年中国糖尿病指南解读、糖尿病的流行病学与药物治疗、糖尿病慢性并发症的机制和治疗进展、糖尿病大血管病变的治疗、氧化应激与糖尿病微血管并发症、糖尿病相关性低血糖的识别与处理等进行专题报告。     

重视媒体在糖尿病教育中的作用

近年来,国内外糖尿病专家高度重视糖尿病教育在糖尿病治疗中的作用,提倡通过教育的方式逐步实现糖尿病三级预防。1995年世界糖尿病日的主题即为“糖尿病教育”,口号是“无知的代价”,即对糖尿病无知将付出高代价,指出糖尿病教育是防治糖尿病的核心。2007版《中国2型糖尿病防治指南》指出“每位糖尿病患者一经诊断就应接受糖尿病教育”。     

国产原研药消渴丸首次入选国家用药指南

2011年10月16日,中华医学会在北京举办的“2010版《中国2型糖尿病防治指南》新闻发布会”上宣布,包括广药集团广州中一药业消渴丸在内的一批治疗糖尿病的药物,经过专家审核甄选,入选国家用药指南。     

罗格列酮治疗2型糖尿病临床分析

罗格列酮(RSG)是一种新型、强效的噻唑烷二酮类口服药,为胰岛素增敏剂.随着糖尿病治疗策略的调整和中国糖尿病防治指南的推广,噻唑烷二酮类药物将逐渐成为2型糖尿病(1[2DM),尤其是肥胖或超重患者治疗的一线药物.现对我院门诊2004年10月至2007年1月初发及单用二甲双胍血糖控制不理想的T2DM患者给予RSG口服,观察其有效性和安全性,报告如下.     

Managing hypertension in patients with type 2 diabetes mellitus.

PURPOSE: Current guideline recommendations for effective strategies to optimize the treatment of patients with concomitant hypertension and type 2 diabetes mellitus are reviewed. SUMMARY: Current estimates indicate that 20 million people in the United States have diabetes, 90-95% of whom have type 2 diabetes mellitus. Type 2 diabetes mellitus is associated with an increased risk of premature death from cardiovascular disease (CVD), stroke, and end-stage renal disease. Hypertension is an extremely common comorbidity in patients with type 2 diabetes mellitus. The coexistence of hypertension in patients with type 2 diabetes is particularly destructive because of the strong linkage of the two conditions with CVD, stroke, progression of renal disease, and diabetic nephropathy. Current guidelines, including those issued by the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, the National Kidney Foundation, and the American Diabetes Association, provide evidence-based recommendations for the treatment of hypertension in patients with type 2 diabetes mellitus. However, studies indicate that guidelines are not widely followed. Therefore, the beneficial effects of appropriate hypertension treatment observed in clinical trials are often not recognized in clinical practice. Pharmacists are ideally positioned to help improve guideline implementation and patient outcome. CONCLUSION: Pharmacists must become more vigilant about following current guidelines for the treatment of patients with concomitant hypertension and type 2 diabetes mellitus. Strategies such as patient education and medication assessment can help to optimize care for these patients and slow the progression to diabetic nephropathy.     

The Role of Lipids in the Development of Diabetic Microvascular Complications

Dyslipidemia is a major factor responsible for coronary heart disease and its reduction decreases coronary risk in patients with diabetes mellitus. However, the association of dyslipidemia with microvascular complications and the effect of intervention with lipid-lowering therapy in diabetes have been less investigated. We present the systematic review of association and intervention studies pertaining to dyslipidemia and microvascular disease in diabetes and also review possible mechanisms. Dyslipidemia may cause or exacerbate diabetic retinopathy and nephropathy by alterations in the coagulation-fibrinolytic system, changes in membrane permeability, damage to endothelial cells and increased atherosclerosis. Hyperlipidemia is associated with faster decline in glomerular filtration rate and progression of albuminuria and nephropathy. Recent evidence also suggests a role of lipoprotein(a) in progression of retinopathy and nephropathy in patients with diabetes mellitus. Lipid-lowering therapy, using single agents or a combination of drugs may significantly benefit diabetic retinopathy and diabetic nephropathy. In particular, hydroxymethyl glutaryl coenzyme A reductase inhibitors may be effective in preventing or retarding the progression of microvascular complications because of their powerful lipid-lowering effects and other additional mechanisms. However, most of the data are based on short-term studies, and need to be ascertained in long-term studies. Until more specific guidelines are available, aggressive management of diabetic dyslipidemia, according to currently accepted guidelines, should be continued for the prevention of macrovascular disease which would also benefit microvascular complications.     

Immunisation and type 1 diabetes mellitus: is there a link?

Recent evidence from animal studies has raised the possibility that immunisation by vaccines can influence the pathogenesis of type I (insulin-dependent) diabetes mellitus. In non-obese diabetic mice and biobreeding rats, complete Freund's adjuvant and bacillus Calmette-Guérin (BCG) vaccine have successfully been used to interrupt the development of diabetes mellitus. This effect is probably mediated by nonspecific suppression of the autoimmune process. A number of attempts have also been made to assess the impact of parenteral immunisation on type 1 diabetes mellitus in humans. Epidemiological evidence has not indicated any clear link between BCG vaccination and the development of diabetes mellitus in humans. Some reports have suggested that natural mumps or mumps vaccinations can induce islet cell autoimmunity, but there is no evidence that mumps-measles-rubella mass vaccination programmes have changed the incidence of diabetes mellitus in any population. An independent protective role of measles virus has been suggested in one study. Recent studies have indicated that enterovirus infections may induce beta cell autoimmunity and clinical diabetes. The only currently available enterovirus vaccine is the poliovirus vaccine which, in theory, could modulate the protection against other enteroviruses by inducing cross-reactive T cell immune responses; however, this hypothesis has not been tested so far. In conclusion, there is no clear evidence that any currently used vaccine can prevent or induce diabetes in humans. However, only a few studies are available on the subject and therefore the possibility of a link between vaccination and diabetes mellitus cannot be excluded.     

Guidelines for prevention and treatment of adverse effects of antipsychotic drugs on glucose–insulin homeostasis and lipid metabolism

Rationale With the antipsychotic drugs available today, especially with some of the newer, atypical antipsychotics, metabolic side effects, such as weight gain, diabetes mellitus and lipid abnormalities, have become a complication to the drug therapy that have to be recognized and treated.Objective The aim of this article is to suggest guidelines for prevention and treatment of adverse effects of antipsychotics on glucose–insulin homeostasis and lipid metabolism, whereas strategies for management of antipsychotic-induced weight gain are summarized elsewhere.Method The guidelines are based on results of experimental and clinical studies presented in the article, as well as on a recently published review of 180 articles in the field.Results Both conventional and atypical antipsychotics can indirectly, by causing obesity, promote development of insulin resistance and type-2 diabetes. In addition, some atypical agents probably directly induce hyperinsulinemia, followed by weight gain, insulin resistance and drug-induced, sometimes insulin-dependent, diabetes.Conclusion In this article, guidelines for the management of adverse metabolic effects of antipsychotics are described.     

Delaying the onset of type 2 diabetes mellitus in patients with prediabetes

The frequency of type 2 diabetes mellitus is increasing at an alarming rate. Prediabetes, also referred to as impaired glucose tolerance (IGT) and/or impaired fasting glucose, is a major risk factor for development of type 2 diabetes mellitus. In addition, IGT has been associated with an increased risk of cardiovascular disease and mortality. Several studies have measured the effects of various interventions in patients with IGT on the development of type 2 diabetes mellitus. Intensive lifestyle modifications through alterations in diet and improvement in exercise have delayed the development of type 2 diabetes mellitus by 58% in patients with IGT. Therapy with metformin, troglitazone, or acarbose also has reduced the progression of IGT to diabetes mellitus by 31%, 49% and 25%, respectively. The mechanisms by which lifestyle interventions and drugs reduce the progression may be through alterations in insulin sensitivity. The American Diabetes Association recommends screening for prediabetes in patients who are 45 years or older and those with a body mass index of 25 kg/m2 or greater who have additional diabetes mellitus risk factors. Pharmacists can promote awareness, counsel patients on intervention strategies to delay the onset of diabetes mellitus, and screen high-risk patients.     

肠道菌群与糖尿病

摘要： 近年来, 肠道菌群与糖尿病的关系成为研究热点。随着对肠道菌群认识的深入, 肠道菌群作为环境因素在调节免疫及代谢性疾病发生中的作用逐渐被大家认识。目前国内外已有大量研究关注肠道菌群影响肥胖和糖尿病的发病机制, 也有研究发现肠道菌群能够从食物难以消化的成分中获取能量, 从而影响人体的能量平衡和代谢。人们通过基因组测序的方法揭示不同类型糖尿病患者肠道菌群的组成、 丰度等, 并在动物体内进行验证, 明确和糖尿病相关的细菌功能。肠道菌群携带的遗传信息可能是未来治疗糖尿病的新突破口。关于2型糖尿病 （T2DM） 及1 型糖尿病 （T1DM） 肠道菌群的研究较多, 但妊娠期糖尿病 （GDM） 肠道菌群的相关研究报道较少。因此, 本文对不同类型糖尿病的肠道菌群特点及肠道菌群参与糖尿病发生的机制作一综述。     

Beta-blockers in the management of hypertension in patients with type 2 diabetes mellitus: is there a role?

It has been conclusively established that treatment of hypertension in patients with type 2 (non-insulin-dependent) diabetes mellitus will significantly reduce the incidence of stroke, heart failure and progression of diabetic complications. Beta-blockers are effective antihypertensive agents which, in long term studies, have proven beneficial in reducing important clinical end-points. However nonselective beta-blockers may have a negative effect on lipid profiles and contribute to hypoglycaemic unawareness, thus preventing their use in some patients with diabetes mellitus. The development of newer and more selective beta-blockers has overcome many of these problems. In addition, some of the newer agents have novel properties such as release of nitric oxide, which theoretically would make them more attractive in patients with diabetes mellitus. Overall, the adverse metabolic effects of beta-blockers do not appear to be important in clinical practice and these agents should no longer be contraindicated in patients with type 2 diabetes mellitus. Their proven cardiovascular benefits would seem to easily tip the balance in favour of their use.     

胰岛素及胰岛素类似物的进展与应用

目的:介绍胰岛素及其类似物的进展和临床应用概况,并评价其疗效与安全性.方法:查阅近期国内外有关文献,进行分析、归纳与评价.结果与结论:大量的循证医学研究证实,胰岛素及其类似物进展迅速,因其可迅速降低餐后血糖,亦被称为"速效胰岛素"或"餐时胰岛素",保证了糖尿病患者高质量的生活,成为当前首选治疗药物,并在治疗糖尿病及其并发症方面显示了良好的临床和市场前景.