AACE积极调整剂量安全达标-科室会

1、AACE启示：启示：积极积极调整剂量调整剂量 安全达标安全达标精选pptAACE引领全球内分泌领域发展 始于1991年年，由全球一流的临床内分泌学领导者创建，现已覆86个个国家和地区，吸引全世界最好的临床内分泌最好的临床内分泌医师医师成为会员 自建立之初制定并发布了内分泌领域众多疾病众多疾病指南指南，指导全球内分泌疾病的规范化治疗，引领全球内分泌领域最新潮的治疗最新潮的治疗理念理念 协会取得了飞速发展，某种程度上使得美国内科学成果在世界上占占有领先有领先地位地位精选pptAACE制定众多内分泌疾病的临床专科指南1.Clinical Practice Guidelines for the Per

2、ioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Patient - 2013 Update: Cosponsored by American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic & Bariatric Surgery 2013 2.Clinical Practice Guidelines for Hypothyroidism

3、in Adults: Cosponsored by the American Association of Clinical Endocrinologists and the American Thyroid Association. 2012 3.American Association of Clinical Endocrinologists Guidelines for Management of Dyslipidemia and Prevention of Atherosclerosis 2012 4.AACE Medical Guidelines for Clinical Pract

4、ice for Diagnosis and Treatment of Menopause 2011 5.American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Diagnosis and Treatment of Acromegaly - 2011 6.Hyperthyroidism and Other Causes of Thyrotoxicosis: Management Guidelines of the American Thyroid Asso

5、ciation and American Association of Clinical Endocrinologists - 2011 7.American Association of Clinical Endocrinologists Medical Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan - 2011 8.American Association of Clinical Endocrinologists Guidelines for Clinical Practice for the D

6、iagnosis and Treatment of Postmenopausal Osteoporosis 2010 9.American Association of Clinical Endocrinologists, Associazione Medici Endocrinologi, and European Thyroid Association Medical Guidelines for Clinical Practice for the Diagnosis and Management of Thyroid Nodules 2010 10. American Associati

7、on of Clinical Endocrinologists Protocol for Standardized Production of Clinical Practice Guidelines - 2010 Update 11. American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for Growth Hormone Use in Growth Hormone-deficient Adults and Transition Patients 2009 Upd

8、ate 12. American Association of Clinical Endocrinologists and American Association of Endocrine Surgeons Medical Guidelines for the Management of Adrenal Incidentalomas 2009 13. American Association Of Clinical Endocrinologists, The Obesity Society, and American Society For Metabolic & Bariatric

9、 Surgery Medical Guidelines For Clinical Practice For The Perioperative Nutritional, Metabolic, And Non Surgical Support Of The Bariatric Surgery Patient 2008 14. AACE Medical Guidelines for Clinical Practice for Diagnosis and Treatment of Hypertension 2006 15. AACE Medical Guidelines for the Clinic

10、al Use of Dietary Supplements and Nutraceuticals 2003 16. AACE Medical Guidelines for the Clinical Practice for Evaluation and Treatment of Male Sexual Dysfunction: A Couples Problem- 2003 Update 17. AACE Medical Guidelines for Clinical Practice for Evaluation and Treatment of Hypogonadism in Adult

11、Male Patients- 2002 Update 18. AACE Medical Guidelines for Clinical Practice for Evaluation and Treatment of Hyperthyroidism and Hypothyroidism 2002 19. AACE/AAES Medical/Surgical Guidelines for Clinical Practice for Management of Thyroid Carcinoma 2001 20. AACE Medical Guidelines for Clinical Pract

12、ice for Diagnosis and Treatment of Hyperandrogenic Disorders 2001 https:/ AJ, et al. Endocr Pract. 2013 Mar-Apr;19(2):327-36.精选ppt考来维仑考来维仑糖苷酶抑制剂糖苷酶抑制剂胰岛素胰岛素其他药物其他药物= 较少的不良事件较少的不良事件 或可能获益或可能获益单药治疗单药治疗*就诊时就诊时 A1c 9.0%无症状无症状有症状有症状疾病的进展疾病的进展* 所列药物顺序为用药推荐等级次序* * 基于临床3期试验的数据图例图例二甲双胍二甲双胍GLP-1 受体激动剂受体激动剂DPP

13、4-抑制剂抑制剂糖苷酶抑制剂糖苷酶抑制剂SGLT-2 *TZDSU/GLN若治疗若治疗3个月后个月后A1c6.5%，加用第二种药物加用第二种药物（两药联合治疗）（两药联合治疗）两药联合治疗两药联合治疗*GLP-1 受体激动剂受体激动剂若若3个月未能达标，个月未能达标，则胰岛素强化治疗则胰岛素强化治疗三药联合治疗三药联合治疗*血糖控制流程图血糖控制流程图生活方式生活方式干预干预(包括医疗干预减轻体重包括医疗干预减轻体重)DPP4-抑制剂抑制剂TZD* SGLT-2基础胰岛素基础胰岛素二甲双胍二甲双胍或其他或其他一线药物一线药物SU/GLN快速释放型溴隐亭快速释放型溴隐亭若若3个月后个月后仍未能达

14、标，仍未能达标，则三药联合治疗则三药联合治疗二甲双胍二甲双胍或其他或其他一线药物一线药物考来维仑考来维仑糖苷酶抑制糖苷酶抑制GLP-1 受体激动剂受体激动剂TZD* SGLT-2基础胰岛素基础胰岛素快速释放型溴隐亭快速释放型溴隐亭二线药物二线药物DPP4-抑制剂抑制剂SU/GLN两药联合治疗两药联合治疗三药联合治疗三药联合治疗 或或加药或胰岛素强化治疗加药或胰岛素强化治疗= 谨慎使用精选ppt精选ppt精选ppt糖尿病药物安全性整体评价一览表Garber AJ, et al. Endocr Pract. 2013 Mar-Apr;19(2):327-36.精选ppt考来维仑考来维仑糖苷酶抑制剂

15、糖苷酶抑制剂胰岛素胰岛素其他药物其他药物= 较少的不良事件较少的不良事件 或可能获益或可能获益单药治疗单药治疗*就诊时就诊时 A1c 9.0%无症状无症状有症状有症状疾病的进展疾病的进展* 所列药物顺序为用药推荐等级次序* * 基于临床3期试验的数据图例图例二甲双胍二甲双胍GLP-1 受体激动剂受体激动剂DPP4-抑制剂抑制剂糖苷酶抑制剂糖苷酶抑制剂SGLT-2 *TZDSU/GLN若治疗若治疗3个月后个月后A1c6.5%，加用第二种药物加用第二种药物（两药联合治疗）（两药联合治疗）两药联合治疗两药联合治疗*GLP-1 受体激动剂受体激动剂若若3个月未能达标，个月未能达标，则胰岛素强化治疗则胰

16、岛素强化治疗三药联合治疗三药联合治疗*生活方式生活方式干预干预(包括医疗干预减轻体重包括医疗干预减轻体重)DPP4-抑制剂抑制剂TZD* SGLT-2基础胰岛素基础胰岛素二甲双胍二甲双胍或其他或其他一线药物一线药物SU/GLN快速释放型溴隐亭快速释放型溴隐亭若若3个月后个月后仍未能达标，仍未能达标，则三药联合治疗则三药联合治疗二甲双胍二甲双胍或其他或其他一线药物一线药物考来维仑考来维仑糖苷酶抑制糖苷酶抑制GLP-1 受体激动剂受体激动剂TZD* SGLT-2基础胰岛素基础胰岛素快速释放型溴隐亭快速释放型溴隐亭二线药物二线药物DPP4-抑制剂抑制剂SU/GLN两药联合治疗两药联合治疗三药联合治疗

17、三药联合治疗 或或加药或胰岛素强化治疗加药或胰岛素强化治疗= 谨慎使用基础胰岛素：具备较好的安全性基础胰岛素：具备较好的安全性 备受专业指南推崇备受专业指南推崇“基础胰岛素基础胰岛素”两联及三联治疗方案中作为两联及三联治疗方案中作为 唯一唯一推荐推荐 若若A1c9%明确推荐作为起始胰岛素方案明确推荐作为起始胰岛素方案精选ppt启示：启示： 积极积极调整剂量调整剂量 安全安全达标达标目标兼顾疗效及目标兼顾疗效及安全性安全性剂量调整是达标的剂量调整是达标的“关键一步关键一步”方法简单、实用性强方法简单、实用性强精选ppt分层设定血糖管理目标目标问题目标问题*对于对于无无合并症及合并症及低血糖风险小

18、的低血糖风险小的患者患者*伴伴合并症及有低血糖合并症及有低血糖风险的患者风险的患者指南指南HbA1c水平水平空腹及餐前空腹及餐前BG水平水平安全性目标安全性目标中国2型糖尿病防治指南2010年版7%3.9-7.2 mmol/L无明显低血糖ADA/EASD 糖尿病诊疗指南2012年版7%7.2 mmol/L且无明显低血糖AACE 糖尿病临床路径2013年版6.5%*6.5%*6.1 mmol/L且无低血糖发生中国2型糖尿病防治指南Inzucchi SE, et al. Diabetes Care. 2012 Jun;35(6):1364-79.Garber AJ, et al. Endocr Pract. 2013 Mar-Apr;19(2):327-36.精选ppt中国糖尿病控制现状不容乐观亚洲糖尿病管理中国协作组在2001至2002年调查了中国华北、华南、华东、华西和东北5大地区的49家市级中心医院的2248例糖尿病患者，结果显示：仅1/4患者A1C控制理想，45%的患者A1C7.5