糖尿病 目錄

2020-02-01
馬偕醫院糖尿病衛教
Toujeo SoloSTAR 使用方式影片介紹

正常人血糖值與糖尿病患者血糖控制目標
血糖異常但還不是糖尿病, 應該多久抽血追蹤一次
低血糖

2020-01-05 14:59
T2DM 第二型糖尿病
2018 糖尿病臨床照護指引糖尿病診斷標準
2018 糖尿病臨床照護指引~ 胰島素
2020 糖尿病血糖控制 第二型糖尿病的藥物治療建議
葡萄糖毒性作用glucose toxicity or glucotoxicity

使用兩種以上藥物組合控制血糖
AACE與ADA建議的血糖控制目標
2019 老年糖尿病臨床照護手冊~ 老年糖尿病人血壓控制目標
2019 老年糖尿病臨床照護手冊~ 血糖控制目標 A1c
2019 老年糖尿病 抗糖尿病藥物選擇
2019 老年糖尿病 低血糖危險因子

轉貼~妊娠高血糖~劉漢文醫師

2020 糖尿病血糖控制 1 大綱
2020 糖尿病血糖控制 2 第一型DM的胰島素治療
2020 糖尿病血糖控制 3 第一型DM非胰島素治療
2020 糖尿病血糖控制 4 第一型DM患者的手術治療
2020 糖尿病血糖控制 5 第二型DM的藥物治療
2020 糖尿病血糖控制 6 第二型DM的初始治療
2020 糖尿病血糖控制 7 第二型DM的組合治療
2020 糖尿病血糖控制 8 第二型DM的組心血管研究
2020 糖尿病血糖控制 9 第二型DM的胰島素治療
2020 糖尿病血糖控制 10 第二型DM的組合注射藥物治療

HbA1c 與疾病的關係

糖尿病藥物的肝毒性
腎功能不良之抗糖尿病藥物OAD選擇 renal insufficiency and choice of anti-diabetic drugs
口服及注射型抗糖尿病藥物總覽

BG
Metformin 雙胍類抗糖尿病藥物

SU
促胰島素分泌劑 (Insulin Secretagogues) 磺醯尿素類及 Glinide
Glibenclamide 磺醯尿素類
Glimepiride 磺醯尿素類
Gliclazide 磺醯尿素類
Glipizide 磺醯尿素類
GLINIDES 非磺醯尿素類促胰島素分泌劑

TZD (也稱為 Glitazones)
抗糖尿病藥物TZD
PIOGLITAZONE TZD類藥物
Rosiglitazone 第二代TZD之一

SGLT2i
SGLT-2i 抑制劑 Dapagliflozin 與 glipizide 比較

AGI
抗糖尿病藥物 阿爾發葡萄糖苷酶抑制劑 (AGI)

DPP4i
DPP4i 二肽基酶-4 抑制劑
Sitagliptin(Januvia) DPP4i
Vildagliptin (Galvus) DPP4i
Saxagliptin (Onglyza)DPP4i
Alogliptin (Nesina) DPP4i
Linagliptin (Trajenta) DPP4i 腎衰竭可以用

SGLT2i
SGLT2i 鈉-葡萄糖共同輸送器-2 抑制劑-抗糖尿病藥物
SGLT2i 可能導致酮酸中毒 2015-05-16 美國 FDA警訊

GLP1-RA
GLP1-RA 類升糖素肽-1受體促效劑(注射型藥物)
Exenatide (Byetta® 降爾糖；Bydureon® 穩爾糖) GLP-1 RA
Liraglutide 胰妥善™ Victoza® GLP-1RA 腎衰竭可用

胰島素
胰島素起始治療選擇與劑量
2020 糖尿病血糖控制 9 T2DM的胰島素治療

DESIGNING AN INSULIN REGIMEN 持續血糖上升如何調整胰島素劑量

DESIGNING AN INSULIN REGIMEN 胰島素劑量 Initial dose

DESIGNING AN INSULIN REGIMEN 基礎胰島素的選擇 

DESIGNING AN INSULIN REGIMEN 基礎胰島素與隨餐胰島素

基礎胰島素類似物
第一代與第二代基礎胰島素類似物 Gla-300 IDeg 之間的比較
長效胰島素類似物在T2DM病患的應用
第二代基礎胰島素類似物Gla-100 與 IDeg-100 基礎胰島素類似物 低血糖機率比較
Gla-300 及 IDeg-100(IDeg)第二代基礎宜島素類似物效益與安全性比較-回顧現有的資料
Tresiba Insulin degludec U100 第二代基礎胰島素類似物  長效
Lantus使用方式與劑量轉換

Toujeo 與 Lantus 比較

uptodate基礎胰島素與隨餐胰島素
使用基礎胰島素與隨餐胰島素調整血糖的流程圖
uptodate 基礎胰島素的選擇
uptodate 基礎胰島素劑量
uptodate 持續血糖上升如何調整基礎胰島素劑量
uptodate 基礎胰島素與隨餐胰島素組合
uptodate 從每天兩次的胰島素轉換成每日一次的胰島素
uptodate 病患自行調整胰島素劑量流程圖
uptodate T2DM使用胰島素的問題排除

uptodate Insulin therapy in type 2 diabetes mellitus TROUBLESHOOTING 2 hypoglycemia
Comparative Efficacy and Safety ofIntermediate-acting, Long-acting andBiosimilar insulins for Type 1 DiabetesMellitus
Basal insulin analogues in the treatment of diabetes mellitus: What progress have we made?

基礎胰島素類似物 Gla-100 與 IDeg-100 低血糖機率比較

Insulin Degludec = IDeg-100 第二代基礎胰島素類似物
Insulin Glargine U100= Gla-100 第一代基礎胰島素類似物

Effect of Insulin Degludec vs Insulin Glargine U100 on Hypoglycemia in Patients With Type 2 Diabetes: The SWITCH 2 Randomized Clinical Trial.  JAMA. 2017;318(1):45.

將病患分成兩組, 一組打 Gla-100, 另一組打 IDeg-100, 兩組都花 16 周調整藥物劑量, 接著以維持劑量治療 16 周,
Importance Hypoglycemia, a serious risk for insulin-treated patients with type 2 diabetes, negatively affects glycemic control.
Objective To test whether treatment with basal insulin degludec is associated with a lower rate of hypoglycemia compared with insulin glargine U100 in patients with type 2 diabetes.
Design, Setting, and Participants Randomized, double-blind, treat-to-target crossover trial including two 32-week treatment periods, each with a 16-week titration period and a 16-week maintenance period. The trial was conducted at 152 US centers between January 2014 and December 2015 in 721 adults with type 2 diabetes and at least 1 hypoglycemia risk factor who were previously treated with basal insulin with or without oral antidiabetic drugs.

低血糖定義, 血糖 < 56
夜間低血糖量測兩個時間, 半夜 12 點 01分以及早上 5點59分.
Interventions Patients were randomized 1:1 to receive once-daily insulin degludec followed by insulin glargine U100 (n = 361) or to receive insulin glargine U100 followed by insulin degludec (n = 360) and randomized 1:1 to morning or evening dosing within each treatment sequence.
Main Outcomes and Measures The primary end point was the rate of overall symptomatic hypoglycemic episodes (severe or blood glucose confirmed [<56 mg/dL]) during the maintenance period. Secondary end points were the rate of nocturnal symptomatic hypoglycemic episodes (severe or blood glucose confirmed, occurring between 12:01 am and 5:59 am) and the proportion of patients with severe hypoglycemia during the maintenance period.

收錄 721 位病患, 580位 完成研究, IDeg-100 與 Gla-100 比較
有症狀低血糖事件 185.6 比 265.4 (每100位病患,每年)
整體發生低血糖的病患 22.5% 比 31.6%
夜間有症狀低血糖 55.2 比 93.6 件 (每100位病患每年)
夜間有症狀低血糖病患數量 9.7% 比 14.7%
嚴重低血糖 1.6% 比 2.4%

整體有症狀低血糖. 與有症狀夜間低血糖機率, 使用 IDeg-100 顯著減少.

Results Of the 721 patients randomized (mean [SD]age, 61.4 [10.5]years; 53.1% male), 580 (80.4%) completed the trial. During the maintenance period, the rates of overall symptomatic hypoglycemia for insulin degludec vs insulin glargine U100 were 185.6 vs 265.4 episodes per 100 patient-years of exposure (PYE) (rate ratio = 0.70 [95% CI, 0.61-0.80]; P < .001; difference, -23.66 episodes/100 PYE [95% CI, -33.98 to -13.33]), and the proportions of patients with hypoglycemic episodes were 22.5% vs 31.6% (difference, -9.1% [95% CI, -13.1% to -5.0%]). The rates of nocturnal symptomatic hypoglycemia with insulin degludec vs insulin glargine U100 were 55.2 vs 93.6 episodes/100 PYE (rate ratio = 0.58 [95% CI, 0.46-0.74]; P < .001; difference, -7.41 episodes/100 PYE [95% CI, -11.98 to -2.85]), and the proportions of patients with hypoglycemic episodes were 9.7% vs 14.7% (difference, -5.1% [95% CI, -8.1% to -2.0%]). The proportions of patients experiencing severe hypoglycemia during the maintenance period were 1.6% (95% CI, 0.6%-2.7%) for insulin degludec vs 2.4% (95% CI, 1.1%-3.7%) for insulin glargine U100 (McNemar P = .35; risk difference, -0.8% [95% CI, -2.2% to 0.5%]). Statistically significant reductionsin overall and nocturnal symptomatic hypoglycemia for insulin degludec vs insulin glargine U100 were also seen for the full treatment period.
Conclusions and Relevance Among patients with type 2 diabetes treated with insulin and with at least 1 hypoglycemia risk factor, 32 weeks' treatment with insulin degludec vs insulin glargine U100 resulted in a reduced rate of overall symptomatic hypoglycemia.