糖尿病治疗新趋势ppt培训课件

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1、糖尿病治療新趨勢時間：2009-04-24(09:00-10:30)地點：花蓮高中主講人：三軍總醫院石光中主任(MD,PhD)1MANAGEMENTOFTYPE2DIABETESORALANTIDIABETICAGENTS(OAD)INSULIN2MANAGEMENTOFTYPE2DIABETESORALANTIDIABETICAGENTS(OAD)INSULIN3ORALANTIDIABETICAGENTSInsulinsecretagogues(sulfonylureas,meglitinides,D-phenylalaninederivati

2、ves)BiguanidesThiazolidinedionesα-glucosidaseinhibitorsPramlintide(Amylin)Exenatide(GLP-1)Sitagliptin(DPP-4inhibitor)4ORALANTIDIABETICAGENTSInsulinsecretagogues(sulfonylureas,meglitinides,D-phenylalaninederivatives)BiguanidesThiazolidinedionesα-glucosidaseinhibitorsPramlintide

3、(Amylin)Exenatide(GLP-1)Sitagliptin(DPP-4inhibitor)5INSULINSECRETAGOGUES:SULFONYLUREASMechanismofActionThemajoractionofsulfonylureasistoincreaseinsulinreleasefromthepancreas.Twoadditionalmechanismsofactionhavebeenproposed-areductionofserumglucagonlevelsandclosureofpotassiumcha

4、nnelsinextrapancreatictissues.6INSULINSECRETAGOGUES:MEGLITINIDESThemeglitinidesarearelativelynewclassofinsulinsecretagogues.Thesedrugsmodulateβ-cellinsulinreleasebyregulatingpotassiumeffluxthroughthepotassiumchannelspreviouslydiscussed.Repaglinidehasaveryfastonsetofaction,with

5、apeakconcentrationandpeakeffectwithinapproximately1hourafteringestion,butthedurationofactionis5-8hours.Becauseofitsrapidonset,repaglinideisindicatedforuseincontrollingpostprandialglucoseexcursions.7INSULINSECRETAGOGUE:D-PHENYLALANINEDERIVATIVENateglinidestimulatesveryrapidandt

6、ransientreleaseofinsulinfromβcellsthroughclosureoftheATP-sensitiveK+channel.Thismaybeasignificantadvantageofthedrugbecausetype2diabetesisassociatedwithlossofthisinitialinsulinresponse.Therestorationofmorenormalinsulinsecretionmaysuppressglucagonreleaseearlyinthemealandresultin

7、lessendogenousorhepaticglucoseproduction.Nateglinidemayhaveaspecialroleinthetreatmentofindividualswithisolatedpostprandialhyperglycemia,butithasminimaleffectonovernightorfastingglucoselevels.Theincidenceofhypoglycemiamaybethelowestofallthesecretagogues,andithastheadvantageofbe

8、ingsafeinindividualswithveryreducedrenalfunction.8治療糖尿病的藥物（1）