Vim Li Cas Kev Tiv Thaiv Raum Yog Lub Hom Phiaj Tseem Ceeb hauv Kev Kho Mob Ntshav Qab Zib?

Thaum Lub Rau Hli 7, 82nd Lub Rooj Sib Tham Txhua Xyoo ntawm AsmeskasMob ntshav qab zibLub koom haum tau xaus rau hauv New Orleans. Raws li cov ntaub ntawv tshawb fawb soj ntsuam tshiab, kev tswj hwm ntawm hyperglycemia tau tham hauv lub rooj sib tham thiab 2022 tsab ntawm "American Diabetes Association/European Association rau Txoj Kev Kawm ntawmMob ntshav qab zib: Kev pom zoo ntawm Hyperglycemia Management hauvHom 2 Ntshav Qab Zib(Draft)" (tom qab no hu ua "Kev Pom Zoo (dav)") Cov ntawv xov xwm tshwj xeeb tau caw Zou Dajin, tus xibfwb ntawm Lub Tsev Haujlwm Saib Xyuas Kev Noj Qab Haus Huv ntawm Shanghai Tenth People's Hospital, los piav qhia meej txog cov ntawv tshiab ntawm "Kev Pom Zoo (Draft). )", uas muaj kev hloov pauv tseem ceeb hauv xya yam xws li cov hom phiaj kho tshuaj thiab cov tswv yim.

Nyem qhov no Kom Paub Cov Lus Qhia Ntxiv txog Yuav Ua Li Cas Cistanche khomob ntshav qab zib hom 2

Tshaj tawm ib txoj kev kho tshuaj kho mob nyob rau hauv etiology, pathology, thiab physiological hloov ntawm cov neeg mob.Hyperglycemiahauvmob ntshav qab zib hom 2cov neeg mob feem ntau tshwm sim los ntawminsulin secretion tsis txaus, insulin tsis kam, thiab txo qis incretin. Yog li ntawd, nyob rau hauv lub ntsej muag ntawm ntau yam ua rau hyperglycemia, tus tshiab version ntawm kev pom zoo kom meej meej tso rau pem hauv ntej lub etiology thiab pathology ntawm hyperglycemia nyob rau hauv cov neeg mob. Raws li cov xwm txheej tshwj xeeb ntawm kev hloov pauv ntawm lub cev thiab cov teeb meem, cov tshuaj yuav tsum raug xaiv, tsis yog "ib qhov loj me haum txhua qhov" zoo li yav dhau los. Zou Dajin tau hais tias "kev tsom mus rau qhov laj thawj thiab kev kho mob ntawm qhov chaw" yog qhov hloov pauv tsis tau pom dua, uas ua rau cov kws kho mob kom nkag siab txog lub hauv paus ntawm hyperglycemia thiab cov teeb meem uas tau tshwm sim hauv txhua tus neeg mob ntshav qab zib ib tus zuj zus, thiab siv tshuaj hauv lub hom phiaj.

Lub hom phiaj tseem ceeb ntawm kev kho tshuaj yog txo qhov kev pheej hmoo ntawmcardiorenal adverse tshwm sim. Tus tshiab version ntawm "Kev pom zoo (Draft)" kos ib qho kev qhia tshiab rau kev kho tshuaj, thiab faib cov neeg mob ntshav qab zib hom 2 rau hauv ob pawg. Tus qub yuav tsum coj "txo qhov kev pheej hmoo ntawm cov xwm txheej tsis zoo cardiorenal" raws li lub hom phiaj tseem ceeb, thiab tawm tswv yim tias ob hom tshuaj tuaj yeem tiv thaiv kev pheej hmoo ntawm cov teeb meem cardiorenal - GLP-1 receptor agonists thiab SGLT-2 inhibitors. Cov pawg qub ntawm cov tshuaj yog cov tshuaj hypoglycemic tswj los ntawm kev txhaj tshuaj. Cov tshuaj sawv cev suav nrog dulaglutide, stigemeglutide, thiab lwm yam.; tom kawg suav nrog ntau yam tshuaj hypoglycemic ntawm qhov ncauj xws li empagliflozin thiab dapagliflozin.

Cov ntawv tshiab ntawm "Kev Pom Zoo (Draft)" pom zoo tias cov neeg mob uas paub tseeb tias cov kab mob atherosclerotic cardiovascular lossis tsis muaj tus kab mob tab sis muaj ntau yam mob plawv (55 xyoo thiab tshaj, rog rog, kub siab, haus luam yeeb, dyslipidemia lossis proteinuria) Rau cov neeg mob uas muaj hom 2. Mob ntshav qab zib, GLP-1 agonists lossis SGLT-2 inhibitors yog nyiam; rau cov neeg mob plawv tsis ua hauj lwm, SGLT-2 inhibitors yog nyiam; rau cov neeg mob nrogmob raum mob, SGLT-2 inhibitors yog nyiam, thiab GLP-1 kuj tseem siv tau agonist. Yog tias tsis muaj cov xwm txheej saum toj no, metformin thiab kev cuam tshuam kev ua neej yuav tsum tau nyiam, thiab kev kho ua ke yuav tsum tau ntxiv raws li tus neeg mob.

Ua raws li "kev poob phaus" raws li ib qho ntawm cov hom phiaj kev tswj hwm ntawmmob ntshav qab zib hom 2. Ib txoj kev tshawb fawb thoob ntiaj teb tau pom zoo tias yog vim li cas vim li cas rog thiab rogmob ntshav qab zib hom 2cov neeg mob tsis tuaj yeem relieved yog vim qhovislet tsis ua haujlwmtshwm sim los ntawm loj deposition ntawm cov rog nyob rau hauv daim siab thiab islets. Tom qab txo cov roj ntau ntau, nws tuaj yeem rov qab tau txog 60 feem pua ​​~ 70 feem pua ​​​​ntawm cov islet muaj nuj nqi. Yog li, "Kev Pom Zoo (Draft)" tau tsim kev poob phaus raws li lub hom phiaj tseem ceeb ntawm hom 2 mob ntshav qab zib.

Zou Dajin tau hais tias kev poob phaus yuav muaj txiaj ntsig tshaj li kev tswj ntshav qab zib. Rau qee cov neeg mob ntshav qab zib hom 2, qhov hnyav ntawm 5 mus rau 10 feem pua ​​tuaj yeem txhim kho cov txheej txheem metabolic, thiab qhov hnyav ntawm 10 feem pua ​​​​mus rau 15 feem pua ​​​​los yog ntau dua tuaj yeem txo qhov kev pheej hmoo ntawm cov teeb meem thiab txawm tias ua rau mob ntshav qab zib. Tsis tas li ntawd, tus tshiab version ntawm "Kev Pom Zoo (Draft)" pom zoo kom cov neeg mob ntshav qab zib hom 2 uas xav kom poob phaus siv GIP / GLP-1 dual receptors nrog "siab heev" cov nyhuv hypoglycemic, "tsawg" kev pheej hmoo ntawm hypoglycemia, thiab "zoo heev" qhov hnyav poob agonist.

Ib qho kev sib xyaw ua ke triple uas muaj metformin tau pom zoo. Rau ntau yam ua rau hyperglycemia, ib qho tshuaj hypoglycemic yog pom tseeb tsis tuaj yeem ua tau raws li cov neeg mob xav tau. "Kev pom zoo (Draft)" pom zoo "224" triple tshuaj kho, uas yog, ib qho kev npaj ruaj khov uas muaj metformin, SGLT-2 inhibitors, thiab DPP-4 inhibitors. Zou Dajin tau hais tias nws qhov zoo yog tias nws tuaj yeem ua tiav cov txheej txheem sib xyaw ua ke, kev sib koom ua ke hypoglycemia, txo qis kev puas tsuaj ntawm hypoglycemia, noj tau yooj yim, muaj kev phiv tsawg, thiab cov nyhuv poob. Txawm hais tias cov tshuaj no tsis tau qhia nyob rau hauv Suav teb, kev sib xyaw ua ke ntawm ob lossis peb lub qhov ncauj hypoglycemic tshuaj tau dhau los ua cov tshuaj hypoglycemic yav tom ntej.

Kev sib xyaw ua ke ntawm GLP-1 receptor agonists thiab insulin ua haujlwm ntev tau hais meej. "Kev pom zoo (Draft)" qhia tias yav tom ntej, cov phooj ywg qab zib yuav tsum tau noj GLP-1 receptor agonists ua ntej noj cov tshuaj insulin, thiab muab lawv nrog cov tshuaj insulin ntev ntev ua ib qho chaw ruaj khov. Zou Dajin tau hais tias txoj kev no tuaj yeem ua rau muaj qhov tsis zoo ntawm kev txhaj tshuaj insulin. Thawj yog kom txo cov koob tshuaj thiab qhov mob ntawm tus neeg mob; thib ob, nws tuaj yeem muaj cov nyhuv hypoglycemic synergistic; thib peb, nws tuaj yeem ua rau qhov hnyav dua thiab txo qhov kev pheej hmoo ntawm hypoglycemia.

Plaub lub ntsiab ntawm kev tswj ntshav qab zib kom zoo yog muab tso rau pem hauv ntej. Raws li Zou Dajin, qhov thiaj li hu ua qhov zoo tshaj plaws hypoglycemia yuav tsum muaj plaub yam: ua ntej, glycosylated hemoglobin ncav cuag tus qauv; thib ob, lub sij hawm piv ntawm cov piam thaj hauv cov hom phiaj (TIR) ​​hauv 24 teev nce mus txog tus qauv; thib peb, tsis muaj hypoglycemia tshwm sim; , qhov hnyav yuav tsum tau khaws cia rau hauv qhov qub thiab tsis nce.

Siv lub neej noj qab nyob zoo ua lub hauv paus rau kev kho tshuaj. Ua ntej tshaj plaws, tsis txhob zaum ntev. Nws raug nquahu kom cov phooj ywg qab zib sawv thiab txav mus ib nrab ib teev, thiab ua haujlwm qeeb qeeb lossis ib ce ua haujlwm yooj yim. Qhov thib ob, cia lub cev tawm hws. Nws raug pom zoo tias cov neeg mob ntshav qab zib yuav tsum ua ntau dua 150 feeb ntawm kev tawm dag zog nruab nrab thiab ntau dua 75 feeb ntawm kev siv zog ntau dua ib lub lis piam. Thib peb, kev cob qhia ua kom lub zog muaj zog tuaj yeem txhim kho cov tshuaj insulin rhiab heev thiab kev ua siab ntev ntawm cov piam thaj. Plaub, mus pw ntxov thiab sawv ntxov kom pw tsaug zog tsis tu ncua. "Kev pom zoo (Draft)" tau taw qhia tias kev pw tsaug zog ntev dua 9 teev thiab tsawg dua 6 teev muaj qhov cuam tshuam tsis zoo rau kev tswj hwm glycated hemoglobin. Zou Dajin tau hais tias kev pw tsaug zog yog qhov tseem ceeb ua rau hyperglycemia thiab teeb meem, thiab ib tus yuav tsum tuav 7-8 teev pw tsaug zog txhua hnub. Thib tsib, tswj kev noj zaub mov kom tsis muaj zog, uas yog, tsim nyog txo lub zog kom tsawg, faib cov khoom noj muaj txiaj ntsig zoo xws li cov protein, rog, thiab cov khoom noj fiber ntau, thiab koom tes nrog kev kho tshuaj kom zoo dua.

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