As the complexity of the human body structure and the complexity of human disease, medicine is an imperfect science. Of many diseases including diabetes, although our understanding than in the past made great progress, but fully understand and master from far away they. It is only through unremitting efforts to continuously explore, to understand the disease closer to the truth, the treatment of disease become more and more correct and perfect. Accumulated in recent years a lot of basic research and clinical study results, we have the concept of type 2 diabetes and strategies have been updated and progress, one of which is to abandon the traditional ladder-style treatment model, replaced as soon as possible active intervention, as soon as possible to actively optimize the combination therapy of oral hypoglycemic agents and early active start-up and use of insulin therapy.
Early and active intervention
Because the large number of patients with diabetes, the prevalence increased at an alarming rate, but also the consequences of death and disability due to serious complications, diabetes has become a major threat to human health diseases. The fundamental purpose of treating diabetes is to minimize the complications of diabetes. In order to reduce complications, especially the risk of macrovascular complications, we deal with type 2 diabetes patients with multiple risk factors for cerebrovascular disease the focus integrated intervention, full compliance, including blood glucose, blood pressure, lipid, anticoagulation, weight reduction. Among them, the strict control of blood glucose to compliance is the primary goal of diabetes treatment. Diabetic microvascular and macrovascular disease risk increased with the increase of HbA1c; and HbA1c decreasing by 1%, would enable the microvascular complications, peripheral vascular disease, diabetes related deaths, the incidence of myocardial infarction and stroke were reduced by 37 %, 43%, 21%, 14% and 12%. Therefore, in order to reduce the complications of diabetes, must be individualized to strict control of blood glucose.
Studies have shown that human existence "metabolic memory" effect, in patients with early long-term strict control of blood sugar will benefit, especially the large blood vessels, any strict control of blood glucose in patients with early, after years of cardiovascular and cerebrovascular disease events would be significantly reduced. Published in recent years and China's national Diabetes Prevention Guide 2007 edition of Type 2 diabetes prevention and treatment guidelines are recommended for newly diagnosed type 2 diabetes, oral hypoglycemic agents should be brought forward to with diet, exercise therapy at the same time. Whether the patient should be clinically obese or overweight based on such individual choice of different oral hypoglycemic therapy, and positive adjustment, so that blood safety standards.
Active as soon as possible to optimize the treatment of oral hypoglycemic agents
As the oral hypoglycemic agents hypoglycemic effect of monotherapy is limited, and any kind of oral hypoglycemic agents can not simultaneously solve all the problems of diabetes, so when an oral hypoglycemic agents can not make blood glucose, it should be used as soon as possible combination therapy of oral hypoglycemic agents. General idea of the joint types of drugs should not be excessive dose of each drug use should not be too large. The so-called oral hypoglycemic agents to optimize combination therapy, including pathophysiology of joint, "foundation - meal time," the joint and complementary advantages of joint three.
Type 2 diabetes, there are two major pathophysiological abnormalities, insulin resistance and insulin secretion is impaired. Insulin sensitizers (such as metformin, rosiglitazone, pioglitazone) primarily address insulin resistance, insulin secretagogues (such as repaglinide, nateglinide and promote the secretion of various sulfonylurea agent) to correct insulin secretion by the main loss. These two drugs combined to meet the pathophysiology of joint, type 2 diabetes can be corrected while the existence of two major pathophysiological abnormalities.
"Basic - meal time" originally referred to short-acting insulin combined with long-term (in effect) insulin combined, the first for the absolute lack of insulin replacement therapy of type 1 diabetes, short-acting insulin before meals with postprandial blood glucose control, and , the long-acting insulin to control fasting (base) blood sugar. Later extended to type 2 diabetes, insulin therapy, oral hypoglycemic agents in recent years that the treatment of type 2 diabetes also can be used "basis - meal time" treatment. Based control instead of fasting insulin (base) blood sugar drug is an insulin sensitizer; instead of prandial blood sugar control drugs nateglinide postprandial insulin secretion promoting agents (repaglinide, nateglinide). These two drugs combined to meet the "basic - meal time," the joint, can control the fasting (base) blood glucose and postprandial blood glucose.
The so-called complementary joint, on the one hand means the combination of drugs have their own strengths, such as a drug for insulin resistance, impaired insulin secretion for the other drugs; a major drug control fasting (base) blood glucose, another major drug postprandial blood glucose control. On the other hand refers to the disadvantage of being a different combination of drugs, such as a drug with low blood sugar or weight gain side effects, another drug should not have these same adverse reactions; a more expensive drug, another drug should be cheaper. And so on.
Optimization of oral hypoglycemic agents in combination therapy, the current recommendation is that most classes insulin secretagogues nateglinide and metformin combination therapy, because they are fully consistent with the joint between the joint optimization of the three, many clinical studies to fully confirmed their joint is the best combination.
Positive start as early as possible and use insulin
If long-term use of oral hypoglycemic medication efficacy become worse when the poor blood sugar control, once enabled insulin therapy significantly improved glycemic control would make. Insulin treatment can rapidly correct the lack of endogenous insulin and control of high glucose toxicity, reduced β-cell apoptosis, restored β-cell function. Therefore, the early start of insulin therapy is the need for blood glucose, but also the need to protect β cells. Well simulate physiological insulin secretion patterns of insulin analogues appear greatly improved insulin therapy safety and effectiveness, so as soon as possible to start insulin therapy.
Published in recent years, several large clinical study showed that our patients with type 2 diabetes start insulin therapy when the average duration of more than 6 years, HbA1c 9.0% above the average are. Insulin treatment is started early enough, use enough positive, is low blood glucose in patients with diabetes is an important reason. What is the timing of starting insulin therapy "as soon as possible?" There is no evidence to support the diagnosis of type 2 diabetes, once insulin therapy is enabled, unless the patient's severe metabolic disorders (such as HbA1c> 10%). For most patients, the general idea of oral hypoglycemic agents by optimizing the treatment of 3 to 6 months, if glycemic control is still not satisfied, which should start insulin therapy.
Early and active intervention
Because the large number of patients with diabetes, the prevalence increased at an alarming rate, but also the consequences of death and disability due to serious complications, diabetes has become a major threat to human health diseases. The fundamental purpose of treating diabetes is to minimize the complications of diabetes. In order to reduce complications, especially the risk of macrovascular complications, we deal with type 2 diabetes patients with multiple risk factors for cerebrovascular disease the focus integrated intervention, full compliance, including blood glucose, blood pressure, lipid, anticoagulation, weight reduction. Among them, the strict control of blood glucose to compliance is the primary goal of diabetes treatment. Diabetic microvascular and macrovascular disease risk increased with the increase of HbA1c; and HbA1c decreasing by 1%, would enable the microvascular complications, peripheral vascular disease, diabetes related deaths, the incidence of myocardial infarction and stroke were reduced by 37 %, 43%, 21%, 14% and 12%. Therefore, in order to reduce the complications of diabetes, must be individualized to strict control of blood glucose.
Studies have shown that human existence "metabolic memory" effect, in patients with early long-term strict control of blood sugar will benefit, especially the large blood vessels, any strict control of blood glucose in patients with early, after years of cardiovascular and cerebrovascular disease events would be significantly reduced. Published in recent years and China's national Diabetes Prevention Guide 2007 edition of Type 2 diabetes prevention and treatment guidelines are recommended for newly diagnosed type 2 diabetes, oral hypoglycemic agents should be brought forward to with diet, exercise therapy at the same time. Whether the patient should be clinically obese or overweight based on such individual choice of different oral hypoglycemic therapy, and positive adjustment, so that blood safety standards.
Active as soon as possible to optimize the treatment of oral hypoglycemic agents
As the oral hypoglycemic agents hypoglycemic effect of monotherapy is limited, and any kind of oral hypoglycemic agents can not simultaneously solve all the problems of diabetes, so when an oral hypoglycemic agents can not make blood glucose, it should be used as soon as possible combination therapy of oral hypoglycemic agents. General idea of the joint types of drugs should not be excessive dose of each drug use should not be too large. The so-called oral hypoglycemic agents to optimize combination therapy, including pathophysiology of joint, "foundation - meal time," the joint and complementary advantages of joint three.
Type 2 diabetes, there are two major pathophysiological abnormalities, insulin resistance and insulin secretion is impaired. Insulin sensitizers (such as metformin, rosiglitazone, pioglitazone) primarily address insulin resistance, insulin secretagogues (such as repaglinide, nateglinide and promote the secretion of various sulfonylurea agent) to correct insulin secretion by the main loss. These two drugs combined to meet the pathophysiology of joint, type 2 diabetes can be corrected while the existence of two major pathophysiological abnormalities.
"Basic - meal time" originally referred to short-acting insulin combined with long-term (in effect) insulin combined, the first for the absolute lack of insulin replacement therapy of type 1 diabetes, short-acting insulin before meals with postprandial blood glucose control, and , the long-acting insulin to control fasting (base) blood sugar. Later extended to type 2 diabetes, insulin therapy, oral hypoglycemic agents in recent years that the treatment of type 2 diabetes also can be used "basis - meal time" treatment. Based control instead of fasting insulin (base) blood sugar drug is an insulin sensitizer; instead of prandial blood sugar control drugs nateglinide postprandial insulin secretion promoting agents (repaglinide, nateglinide). These two drugs combined to meet the "basic - meal time," the joint, can control the fasting (base) blood glucose and postprandial blood glucose.
The so-called complementary joint, on the one hand means the combination of drugs have their own strengths, such as a drug for insulin resistance, impaired insulin secretion for the other drugs; a major drug control fasting (base) blood glucose, another major drug postprandial blood glucose control. On the other hand refers to the disadvantage of being a different combination of drugs, such as a drug with low blood sugar or weight gain side effects, another drug should not have these same adverse reactions; a more expensive drug, another drug should be cheaper. And so on.
Optimization of oral hypoglycemic agents in combination therapy, the current recommendation is that most classes insulin secretagogues nateglinide and metformin combination therapy, because they are fully consistent with the joint between the joint optimization of the three, many clinical studies to fully confirmed their joint is the best combination.
Positive start as early as possible and use insulin
If long-term use of oral hypoglycemic medication efficacy become worse when the poor blood sugar control, once enabled insulin therapy significantly improved glycemic control would make. Insulin treatment can rapidly correct the lack of endogenous insulin and control of high glucose toxicity, reduced β-cell apoptosis, restored β-cell function. Therefore, the early start of insulin therapy is the need for blood glucose, but also the need to protect β cells. Well simulate physiological insulin secretion patterns of insulin analogues appear greatly improved insulin therapy safety and effectiveness, so as soon as possible to start insulin therapy.
Published in recent years, several large clinical study showed that our patients with type 2 diabetes start insulin therapy when the average duration of more than 6 years, HbA1c 9.0% above the average are. Insulin treatment is started early enough, use enough positive, is low blood glucose in patients with diabetes is an important reason. What is the timing of starting insulin therapy "as soon as possible?" There is no evidence to support the diagnosis of type 2 diabetes, once insulin therapy is enabled, unless the patient's severe metabolic disorders (such as HbA1c> 10%). For most patients, the general idea of oral hypoglycemic agents by optimizing the treatment of 3 to 6 months, if glycemic control is still not satisfied, which should start insulin therapy.
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