资讯内容 Content

[ADA2012]吡格列酮研究进展及安全性
——高鑫教授专访
国际糖尿病网版权所有,谢绝任何形式转载,侵犯版权者必予法律追究。

作者:高鑫 2012/6/11 14:54:00    加入收藏
内容概要:国际糖尿病:当二甲双胍单药治疗不足以很好地控制HbA1c水平时,推荐联合用药。联合另一种药物的合适时机是什么? 高鑫教授:很难说出合适的时机。联合药物只是根据HbA1c水平。如果患者的HbA1c水平不能达标的话,就需要联合另一种药物。

  高鑫  教授  博导
  复旦大学附属中山医院                    内分泌科 主任
  复旦大学附属中山医院                    副院长
  中华内分泌学分会《肝病与代谢》   学组组长

  <International Diabetes>: When monotherapy with metformin is not enough to maintain a good HbA1c level, a second drug may be recommended. What is the appropriate timing to add a second drug with metformin?
  Prof. Gao: It is very hard to say according to time but only according to HbA1c level. If the patient’s HbA1c level does not get to target, then we may need another drug combination for the patient.

  《国际糖尿病》:当二甲双胍单药治疗不足以很好地控制HbA1c水平时,推荐联合用药。联合另一种药物的合适时机是什么?
  高鑫教授:很难说出合适的时机。联合药物只是根据HbA1c水平。如果患者的HbA1c水平不能达标的话,就需要联合另一种药物。

  <International Diabetes>:  What principles should be followed for the ideal combination therapy?
  Prof. Gao:Doctors in China follow the recommendations of the ADA Guidelines and in recent years, since 2007, we have had our own Chinese Guidelines from the Chinese Diabetes Association with a second edition in 2010. These guidelines are very similar to the ADA Guidelines. So to find that best combination, the doctor needs to be following those guidelines. Very professional doctors who work in first grade hospitals and university affiliated hospitals are expert doctors according to our guidelines. Unfortunately there are many doctors in China who are not properly qualified so it depends on an appropriate education program and course of study to follow the guidelines and treat patients appropriately.

  《国际糖尿病》:理想联合治疗的原则是什么?
  高鑫教授:中国医生依据ADA指南的推荐给予联合治疗。2007年,中国糖尿病学会公布了《中国2型糖尿病防治指南》,2010年对指南进行了修订。中国指南与ADA指南非常相似。因此,为了给予最佳的联合治疗,医生可以参考ADA指南和中国指南。在级别比较高的医院和大学附属医院工作的专门研究糖尿病的医生会遵循指南。然而,中国很多医生并不是非常了解糖尿病,因此需要开展合适的教育项目和学习课程,让他们能够遵循指南,正确治疗患者。

  <International Diabetes>: With those principles in mind, what is your opinion of the combination of metformin and pioglitazone?
  Prof. Gao: Before TZDs were launched in China, we only had one sensitizer, metformin, but now we have two from which to make a choice. We now have the option to select another drug especially for the patient with type 2 diabetes who is overweight or obese. There was a paper published in the New England Journal of Medicine in 2010. In patients with NASH who were treated with pioglitazone, the metabolic factors improved with liver fat content and insulin resistance improving. This is significant for the management of type 2 diabetes.
  《国际糖尿病》:您如何看待二甲双胍和吡格列酮联合治疗?
  高鑫教授:TZD类药物在中国上市之前,我们只有二甲双胍这一个胰岛素增敏剂。吡格列酮的出现拓宽了T2DM治疗药物的选择,尤其是对于超重或肥胖的T2DM患者。而且,2010年发表于《新英格兰医学杂志》的一项研究显示,吡格列酮能够逆转非酒精性脂肪性肝炎(NASH),它能减少受试者肝脏脂肪的含量,进而改善其代谢指标与胰岛素敏感性,这一效应对于T2DM的管理很有意义。
 

  <International Diabetes>:  When is it that you decide to combine the metformin with TZDs?
  Prof. Gao: First line therapy for type 2 diabetes is lifestyle change and then metformin. If the patient cannot get to target then we choose sulfonylurea and sometimes choose insulin. This is also an opportunity to choose TZDs but not every doctor is familiar with these drugs because after 2005/6 there was adverse news regarding the TZDs so physicians were very cautious to use TZDs. So it was very popular in China to use metformin and its low cost is a reason for this.

  《国际糖尿病》:何时联合应用二甲双胍和TZD类药物?
  高鑫教授:T2DM的一线治疗是生活方式干预,之后是二甲双胍治疗。如果患者血糖不能达标,则联合磺脲类药物,有时会应用胰岛素。也可能会联合TZD类药物,但并不是每位医生都熟悉TZD类药物。因为在2005~2006年左右出现了TZD类药物的不利新闻,所有医生应用TZD类药物的时候非常谨慎。因此,在中国医生十分常用的是二甲双胍,价格低是用药的原因之一。

  <International Diabetes>: You subspecialize in studying the liver. Why is that?
  Prof. Gao: The liver is a very important organ in processing lipids, carbohydrates and protein. There are many trials and experiments have demonstrated that increased fat content of the liver increases insulin resistance so that is why I selected this area as a research interest.
  《国际糖尿病》:您主要研究肝脏。为什么选择这个领域?
  高鑫教授:肝脏是参与脂质、蛋白质和碳水化合物代谢的一个非常重要的器官。很多临床试验和基础研究显示,肝脏脂肪含量增加会诱发胰岛素抵抗,因此我选择研究肝脏。
 

  <International Diabetes>:  Non-alcoholic fatty liver disease is closely associated with type 2 diabetes. Pioglitazone has been shown to decrease liver fat and lead to improvement in subjects with NASH. What is your opinion about the findings for pioglitazone’s hepatic benefits?
  Prof. Gao: In our research and experience, we found pioglitazone can reduce insulin resistance because liver fat content increases insulin resistance in the liver, so according to the mechanism of pioglitazone or rosiglitazone, these drugs can improve insulin resistance partially by reducing liver fat content.
  《国际糖尿病》:非酒精性脂肪肝与T2DM紧密相关。吡格列酮能够减少肝脏脂肪含量,改善非酒精性脂肪性肝炎(NASH)。您如何看待吡格列酮对肝脏有益作用的研究结果?
  高鑫教授:根据我们的研究和经验,我们发现吡格列酮能够改善胰岛素抵抗,这是由于肝脏的脂肪含量与胰岛素抵抗相关,因此根据吡格列酮和罗格列酮的作用机制,这两个药物能够通过减少肝脏的脂肪含量来改善胰岛素敏感性。
 



[1]  [2]  下一页

 延伸阅读
网站用户: 殷学 时间:2012/9/29 15:32:31
佩服!

注册

网友评论仅供其表达个人看法,并不表明国际糖尿病同意其观点或证实其描述。 发表评论需登陆

相关标签

 
关于本站 | 设为首页 | 加入收藏 | 站长邮箱 | 友情链接 | 版权申明

国际糖尿病(www.idiabetes.com.cn)对刊载的所有文章、视频、幻灯、音频等资源拥有全部版权。未经本站许可,不得转载。

国际糖尿病 版权所有  2008-2018 idiabetes.com.cn  All Rights Reserved