糖尿病简介及治疗课件.ppt

* 目前2型糖尿病降糖药物的作用靶点 近年来研发出许多可以单独、多药联合或与胰岛素联合应用的降糖新药，他们有不同的作用机制1。这些成果为医生提供了更多的2型糖尿病治疗药物的选择余地，并为联合治疗提供更多选择。 双胍类药物（二甲双胍）的作用机制，主要是通过减少肝脏糖原分解和糖异生而使肝脏葡萄糖输出减少，此外还有增加肌肉组织摄取葡萄糖的作用1。 磺脲类药物（例如，格列美脲、格列本脲）以及美格列奈类（例如，瑞格列奈、那格列奈）都是胰岛素促泌剂，使胰岛β细胞分泌胰岛素增加。磺脲类药物与胰岛β细胞表面特异的受体结合，引起细胞膜及胞内一系列变化，导致胰岛素颗粒释放。美格列奈类药物也作用于胰岛β细胞表面特异的受体，但是引起的胰岛素分泌更为迅速、作用持续时间更加短暂1。 α-糖苷酶抑制剂的作用并不针对2型糖尿病的任何一种病生理基础，而是通过抑制α-糖苷酶及小肠上皮细胞刷状缘的其他酶类，从而阻止寡聚糖、双糖等分解为单糖进而吸收的过程1 。 噻唑烷二酮类（例如罗格列酮、曲格列酮）是外周组织胰岛素增敏剂。他们与肌肉、脂肪组织中的核受体结合使之活化，增加参与糖脂代谢的某些基因的表达1 。 胰高血糖素样多肽-1是食物刺激下由肠细胞分泌的促进胰岛素分泌的激素。与我们前面介绍的降糖药不同的是，胰高血糖素样多肽-1（包括exenatide ）都没有口服剂型，必须静脉应用2。 Pharmacologic Targets of Current Drugs Used in the Treatment of T2DM The number of antihyperglycemic drugs that can be used either alone or in combination, or in combination with insulin, has grown markedly in recent years, and includes agents with widely differing modes of action.1 These developments translate into increasing therapeutic options for type 2 diabetes mellitus (T2DM) and complex decision-making for physicians. The major mechanism of action of biguanides (eg, metformin) is to decrease hepatic glucose output primarily by decreasing gluconeogenesis, and to a lesser degree increasing glucose uptake by skeletal muscle.1 Sulfonylureas (eg, glimepiride, glyburide) and meglitinides (eg, nateglinide, repaglinide) stimulate insulin secretion from the β-cell. Sulfonylureas bind to a specific cell-surface receptor causing metabolic changes that promote exocytosis of insulin-containing vesicles. Meglitinides also bind to the sulfonylurea receptor with similar effects, although with a relatively prompt and brief stimulatory effect.1 α-glucosidase inhibitors such as acarbose do not target any specific pathophysiological defect in T2DM. Rather, they act by inhibiting α-glucosidase and other intestinal brush-border enzymes responsible for the breakdown of oligosaccharides and disaccharides to monosaccharides suitable for absorption.1 Thiazolidinediones (eg, rosiglitazone, pioglitazone) act as