1、口服降糖藥物課件Buse JB et al. In: Williams Textbook of Endocrinology. 10th ed. Philadelphia: WB Saunders; 2003:14271483; DeFronzo RA. Ann Intern Med. 1999;131:281303; Inzucchi SE. JAMA 2002;287:360-372; Porte D et al. Clin Invest Med. 1995;18:247254. DPP-4=二肽基肽酶 4; TZDs=噻唑烷二酮類.胰腺血糖水平血糖水平肌肉和脂肪肝臟TZDs磺脲類格列奈類T

2、ZDs-糖苷酶 抑制劑胃腸道DPP-4 抑制劑抑制劑DPP-4抑制劑抑制劑Creutzfeldt W, et al. Diabetologia. 1985;28:565-573; Perley MJ, et al. J Clin Invest. 1967;46:1954-1962; Creutzfeldt W. Exp Clin Endocrinol Diabetes. 2001;109(Suppl 2):S288-S303. Unger RH, Eisentraut AM. Arch Intern Med.1969;123:261266.$GLP-1及其類似物和及其類似物和DPP-4靜脈血糖

3、濃度靜脈血糖濃度(mg/dL)時間時間(分鐘分鐘)C肽肽 (nmol/L)200100001601201800160120180時間時間(分鐘分鐘)0202腸促胰素效應腸促胰素效應口服葡萄糖口服葡萄糖 靜脈用葡萄糖靜脈用葡萄糖*平均值平均值 SE; N=6; *p .05; 01-02=葡萄糖輸注時間。葡萄糖輸注時間。Nauck MA, et al. J Clin Endocrinol Metab. 1986;63:492-498. Copyright 1986, The Endocrine Society . Drucker DJ. Diabetes Care. 2003;26:2929-2

4、940.; Perley MJ, Kipnis DM. J Clin Invest. 1967;46:1954-1962.;Nauck M, et al. Diabetologia. 1986;29:46-52. Drucker DJ, et al. Diabetes Care. 2003;26:2929-2940Adapted from Flint A, et al. J Clin Invest. 1998;101:515-520; Adapted from Larsson H, et al. Acta Physiol Scand. 1997;160:413-422; Adapted fro

5、m Nauck MA, et al. Diabetologia. 1996;39:1546-1553; Adapted from Drucker DJ. Diabetes. 1998;47:159-169.進食促進GLP-1分泌增加細胞反應 細胞細胞:增強葡萄糖依賴的胰島素分泌增強葡萄糖依賴的胰島素分泌促進飽脹感促進飽脹感降低食欲降低食欲降低細胞負荷細胞細胞:減少餐后胰高血糖素分減少餐后胰高血糖素分泌泌肝臟肝臟: 胰高血糖素水平下降胰高血糖素水平下降減少肝糖輸出減少肝糖輸出胃胃:延緩胃排空延緩胃排空* 兩餐之間至少間隔6小時詳見相關的使用說明和安全信息BYETTA European Packa

6、ge Insert, 2007.百泌達重要安全性信息l 不良反應不良反應l最常見的不良反應為惡心、嘔吐、腹瀉、抖動感、頭暈、頭痛及消化不良See accompanying Prescribing InformationACE = angiotensin converting enzymes; NSAID = nonsteroidal anti-inflammatory drug詳見藥物使用說明中國2型糖尿病防治指南生活方式干預生活方式干預如血糖控制不達標 (HbA1c7.0%)，則進入下一步治療主要治療路徑備選治療路徑一線藥物治療二線藥物治療三線藥物治療四線藥物治療二甲雙胍胰島素促分泌劑或-糖苷酶抑制劑胰島素促分泌劑或 -糖苷酶抑制劑噻唑烷二酮類藥物或DPP-4抑制劑基礎胰島素或