地特胰岛素与瑞格列奈治疗老年2型糖尿病的体会

目的:探讨地特胰岛素+瑞格列奈在老年2型糖尿病中的应用价值.方法:选择老年2型糖尿病病患74例,采用数字抽签的方式将之随机等分成A、B两组.其中,A组联合应用地特胰岛素与瑞格列奈,B组应用预混胰岛素.观察两组用药后相关血糖指标的变化情况,比较低血糖发生率等指标.结果:A组治疗后的2hBG、MACE、FBG与HbAlc指标水平均明显优于B组(P<0.05).A组的低血糖发生率(2.7％)比B组(21.62％)更低(P<0.05).结论:积极对老年2型糖尿病病患施以地特胰岛素+瑞格列奈治疗,有助于促进其血糖水平的降低,提高用药安全性.     

Pharmacological treatment of diabetes in the elderly

Diabetes mellitus (DM) is a highly prevalent disease in the geriatric population. The elderly are at increased risk for adverse drug reactions (hypoglycemia) compared with the young due to physiological changes associated with age, high number of comorbidities and polypharmacy usually present, causing changes in drugs pharmacokinetics and pharmacodynamics. At present, there are wide therapeutic options to treat DM, so it is important to know the different drug families and their potential side effects. As a general principle, metformin remains an appropriate option for the management of DM in the elderly, first-generation sulfonylureas (chlorpropamide) is preferable not to use due the high risk of hypoglycemia. Some thiazolidinediones have been associated with heart failure, as their use in the elderly is controversial. About the new drugs that act on the DPP-4, results are promising with a low risk profile of adverse reactions. We must consider the use of human insulin or insulin analogues in the elderly when not achieved with other hypoglycaemic agents. At the start of therapy is important to establish the most appropriate management goals based on patient comorbidities and their life expectancy.     

Liraglutide for the treatment of type 2 diabetes

This paper presents a summary of the evidence review group (ERG) report into the clinical effectiveness and cost-effectiveness of liraglutide in the treatment of type 2 diabetes mellitus, based upon the manufacturer's submission to the National Institute for Health and Clinical Excellence (NICE) as part of the single technology appraisal process. The manufacturer proposed the use of liraglutide as a second or third drug in patients with type 2 diabetes whose glycaemic control was unsatisfactory with metformin, with or without a second oral glucose-lowering drug. The submission included six manufacturer-sponsored trials that compared the efficacy of liraglutide against other glucose-lowering agents. Not all of the trials were relevant to the decision problem. The most relevant were Liraglutide Effects and Actions in Diabetes 5 (LEAD-5) (liraglutide used as part of triple therapy and compared against insulin glargine) and LEAD-6 [liraglutide in triple therapy compared against another glucagon-like peptide-1 agonist, exenatide]. Five of the six trials were published in full and one was then unpublished. Two doses of liraglutide, 1.2 and 1.8 mg, were used in some trials, but in the two comparisons in triple therapy, against glargine and exenatide, only the 1.8-mg dose was used. Liraglutide in both doses was found to be clinically effective in lowering blood glucose concentration [glycated haemoglobin (HbA1c)], reducing weight (unlike other glucose-lowering agents, such as sulphonylureas, glitazones and insulins, which cause weight gain) and also reducing systolic blood pressure (SBP). Hypoglycaemia was uncommon. The ERG carried out meta-analyses comparing the 1.2- and 1.8-mg doses of liraglutide, which suggested that there was no difference in control of diabetes, and only a slight difference in weight loss, insufficient to justify the extra cost. The cost-effectiveness analysis was carried out using the Center for Outcomes Research model. The health benefit was reported as quality-adjusted life-years (QALYs). The manufacturer estimated the cost-effectiveness to be ￡ 15,130 per QALY for liraglutide 1.8 mg compared with glargine, ￡ 10,054 per QALY for liraglutide 1.8 mg compared with exenatide, ￡ 10,465 per QALY for liraglutide 1.8 mg compared with sitagliptin, and ￡ 9851 per QALY for liraglutide 1.2 mg compared with sitagliptin. The ERG conducted additional sensitivity analyses and concluded that the factors that carried most weight were: in the comparison with glargine, the direct utility effects of body mass index (BMI) changes and SBP, with some additional contribution from HbA1c, in the comparison with exenatide, HbA1c, with some additional effects from cholesterol and triglycerides in the comparison with sitagliptin, HbA1c and direct utility effects of BMI changes. The European Medicines Agency has approved liraglutide in dual therapy with other oral glucose-lowering agents. NICE guidance recommends the use of liraglutide 1.2 mg in triple therapy when glycaemic control remains or becomes inadequate with a combination of two oral glucose-lowering drugs. The use of liraglutide 1.2 mg in a dual therapy is indicated only in patients who are intolerant of, or have contraindications to, three oral glucose-lowering drugs. The use of liraglutide 1.8 mg was not approved by NICE. The ERG recommends research into the (currently unlicensed) use of liraglutide in combination with long-acting insulin.     

前列腺癌的手术治疗现况

前列腺癌治疗方法根据临床分期、细胞分化、年龄、全身情况、经济和家庭境况,以及个人心理状态而定。年轻(<70岁)、身体较好、临床分期B_2期以下、分化较好者,做根治性前列腺切除术,能提高存活率。根治性切除是指手术范围,包括:整个前列腺、精囊,甚至盆腔淋巴清扫;不是将癌细胞根     

前列腺癌的手术治疗现况

前列腺癌治疗方法根据临床分期、细胞分化、年龄、全身情况、经济和家庭境况,以及个人心理状态而定.年轻(＜70岁)、身体较好、临床分期B2期以下、分化较好者,做根治性前列腺切除术,能提高存活率.     

Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes

Background

the primary objective was to develop an adjective checklist, the Fatigue Quality List (FQL), aimed at assessing different perceptions of fatigue.

Methods

961 participants filled out the FQL (28 adjectives). A component and confirmatory factor analyses were performed and psychometric properties were evaluated. Differences on factor scores between different patients' groups were investigated and pre- and post treatment scores were compared in demonstrating change of perceptions after treatment of fatigue.

Results

Four independent factors were found with adequate psychometric properties. Different perceptions were found between the patients' groups. Patients who were recovered after treatment for fatigue showed similar scores on the factors as healthy controls.

Conclusion

The FQL appears to be a promising tool in measuring different perceptions of fatigue, which can be especially interesting for clinical practice.     

Development and validation of the insulin treatment appraisal scale (ITAS) in patients with type 2 diabetes

Background  

Timely initiation of insulin therapy in type 2 diabetes is important to achieve metabolic control but can be hindered by negative perceptions of patients regarding insulin treatment. To assess the appraisal of insulin therapy of persons with type 2 diabetes, we developed the insulin treatment appraisal scale (ITAS) and tested its reliability and validity in insulin treated type 2 diabetes patients.     

病毒性乙型肝炎的临床治疗现状

乙型肝炎是由乙型肝炎病毒(HBV)侵犯人体肝脏后出现的一系列免疫应答反应,机体通过特异性体液免疫(抗-HBs)和细胞免疫而清除病毒,使患者恢复健康,但是部分患者由于抗体产生不足或抗体效价不高,缺乏有效的细胞毒T淋巴细胞等因素,导致不能将病毒清除,以至HBV在受感染的肝细胞内不断复制增殖,不断释放并进人未感染的肝细胞,同时诱发一系列的免疫细胞对受感染的肝细胞的反应,导致肝细胞的损害和炎症.