3 1 3 III2

1
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• ????? 3 ??? 1 3-?? ????????? ?????? III-2
  ????? ?????????? ????????? ????????

2
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• ?????? ????? ??????????, ???????????
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3
?????/UKPDS ??????????? ????????? ??????
????????????



9
?????????
8
HbA1c ()
????????
7
6
0
??????? ???????
UKPDS Study Group 1998
4
??????? ??????????
Henry 1998
5
??????????? ????????????
GLP-1 (???????????) ?????????? ?? ???????????
?????????????? ?????? ???????? ????????
???????????? ? ??????????????????? ?????????? ??
??????????? ??????????????
???????? ?????????????? ??????????????????? ?
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??????????????
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???????? ? ?????? ?????????
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?? ???????????? ?????????????????????
6

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• ???????? ? ??????? ??????????

7
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  ??????? ???? ????? ?????????
• ???????? ???????????????? ????? ????? ??, ???
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8
????????? ?????????
Canadian Diabetes Association 2003
9
???????? ??????? ????????

• ???????, ?? ??????? ? ????????
• ???????? ??????? ???????????????
• ?????? ???? ?????
• ????? ??????????? ???????
• ???????? ???????? ???????? ????????????????

Rubin 2005
10
????? ??? ??????????? ?????????????? ??????????
????????????
1CDA 2003, 2ADA 2004, 3 IDF 2005
11
???????? ??????? ????? ??????????? ?
CDA 2003
12
?????????? ??? ??????????? ?

• ??? ?????????? ????????????? ??? ????? 2-3 ?????
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  ?????????
• ?????????? ????????????? ???????? ?????, ???
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13
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14
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15
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16
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17
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18
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19
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20
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21
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22
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  ??????????
• ???????? ????????
• ???LDL-cholesterol ????????? ? ??? ??????????

23
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• ?????????? ?????? ????????, ?????? ?????????
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• ???????? ???????????????
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24
???? ??????????? ?????????????

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• ???????? ?? ????????? ????? ??????????? ????

25
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• ????????? ????????? ?????? (????????
  ????????????????)
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26
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27
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  ??????????? ?????????

28
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29
(No Transcript)
30
????? ????????????????????? ???? ?????? ????
????? ????51? ????????? ??????, HbA1C 9.5???
32, ??150/95, ??? ?? ?????????. ?????????? ??
?????, ?? ??????? ?????????? ??? ??????? ???????
31
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32
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• 1.??? ? ??????????? ?????? ???????? ????????????.
  
• ?????????
• ??????????????
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33
??????? ??????

• 2. ??? ? ?????? ?????????? ????-?????????????
  ??????????????
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  ?? ???????

34
??????? ??????

• 3. ?? ??????? ? ?????
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  ?????
• ????????????? ????????? ???????? ????????? ????
  ?????? ? ??? ????? ????????? ????? ? ???? ?????

35
??????? ??????

• 4.JL 45-? ??????? ? ????????? ? 5 mg glyburide
  ? 500 mg metformin ????????? ? ???????? ????
  ???????????? ??????????? ????????? 5.36.7mmol/L,
  ???? ???? ??????? ?????, ???? 3- 4-??
  ?????????????? ?????????? ? ????????.
• ????????
• ????????? ??????????
• ???????? ??????????
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• ???????? ??????????

36
??????? ??????

• 5. ??????????????????? ????????? ??????????? ????
  ?????????? ? ????????????
• ??? ? ??? ?????
• ??? ???? ????????
• ?????? ??????? ? ?????? ?????????????
• ??? ????? ??????? ??????

37
???????????

• b
• b
• a
• c
• c

38
???????????? ????

• UK Prospective Diabetes Study (UKPDS) Group.
  Intensive blood glucose control with
  sulphonylureas or insulin compared with
  conventional treatment and risk of complications
  in person with diabetes with type 2 diabetes
  (UKPDS 33). Lancet 1998 352 837-53.
• Ahmann AJ, Riddle MC. Current blood glucose
  lowering medicines for type 2 diabetes. Postgrad
  Med 2002 111(5) 32-46.
• Henry RR. Type 2 diabetes care the role of
  insulin-sensitizing agents and practical
  implications for cardiovascular disease
  prevention. Am J Med 1998 105(1A) 20S-26S.
• Luna B, Feinglos MN. Blood glucose-lowering
  medicines in the management of type 2 diabetes
  mellitus. Am Fam Physician 2001 63(9) 1747-56.
• Canadian Diabetes Association Clinical Practice
  Guidelines Expert Committee. Clinical Practice
  Guidelines for the Prevention and Management of
  Diabetes in Canada. Can J Diab 2003 27(supple
  2).
• Yki-Jarvinnen H, Ryysy L, Nikkila K, et al.
  Comparison of bedtime insulin regimen in person
  with diabetes with type 2 diabetes mellitus a
  randomized control trial. Annals Intern Med 1999
  130(5) 89-96.
• Amylin Pharmaceuticals Inc and Eli Lilly Co.
  Byetta (cited 2005July 25) (16 screens).
  (Available from http//www.byetta.com)
• Rubin Rr. Adherence to pharmacologic therapy in
  patients with type 2 diabetes mellitus. Am J Med
  2005 118(5A) 275-345.