文档介绍：糖尿病为进展性疾病,特征表现为:β细胞功能下降血糖控制恶化微血管并发症大血管并发症风险增加在控制血糖的治疗中,医生、患者将面临着:%–upperlimitofnormalrangeMedianHbA1c(%)Conventional* target<%†(years)023451ADOPTMetforminGlibenclamideRosiglitazone*Dietinitiallythensulphonylureas,insulinand/ormetforminifFPG>15mmol/L;†,n=:352:854–65;al(ADOPT).NEJM2006;355(23):2427–43Glibenclamide(n=277)YearsfromrandomisationInsulin(n=409)Metformin(n=342)Conventionaltreatment(n=411); dietinitiallythensulphonylureas,insulinand/ormetforminifFPG>15mmol/LUKPDS:upto8kgin12yearsADOPT:(kg)Rosiglitazone,()Metformin,-(--)**Glibenclamide,-(-)**Changeinweight(kg):352:854–=atbaseline;al(ADOPT).NEJM2006;355(23):2427–43p< **(%)1039051015202530354045RosiglitazoneMetforminGlibenclamide12Hypoglycaemia,events/patient/year*051020GlargineNPH*;26:3080;al(ADOPT).NEJM2006;355:2427–43大脑胰岛素分泌(葡萄糖依赖)胰高血糖素分泌胰岛素合成细胞量胰腺肝脏肝糖输出能量摄取胃肠道减少动力SlideNo*与人类GLP-1的氨基酸有97%同源与人类GLP-1的氨基酸有53%同源Studyduration:Liraglutide26weeks;exenatide30weeks. 1LEAD1,2,3,4,5meta-analysisofantibodyformation;Dataonfile;;28:1092人类GLP-1LiraglutideExenatide患者使用后抗体增加的比例Liraglutide1020406080100Exenatide+ metformin243%%;29:717正常IFG2型糖尿病