05b Anp Endokrinologija

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Transcript of 05b Anp Endokrinologija

TRETMAN I SLEDEWE KAJ TIP 2 DIJABETES

2 15.3.2012 , , . 1. , 2. , 3. 4. 5. 6. . 1 < 7.0% (53 /), 1 (4-6% 20-42 /) .. ( 130/80 ). : > 1 , > 1.3 ,, < 1.7, < 2.5 /. (100 ) 50 60 , ( 50- , , , , . , 2 ., . . . 2 , (, , , ). ( , , ). 2 . , . . 1 < 7% (53 /) 1 6 , , ( , (-). , , , , 2 .. 1 7.19.0% (54-75 /) ( , ). , , 1 8%(64 /) 6 , 1 9.112% (76-108 /) 1 -2 ( , ( ) -1 ( ) , , , . , , . (- ) , . 4060% 2 . ( ) 130/80 . - ( , , (-). > 140 > 90 . : ( ) (12.525 ) - . . - ( ) , : ( - ) : ( - ) : ( - ) : ( - ) 1. : , , , , , . , 35 /2. 2. , -. . 3. , , . 4. , , , + + - + - + . , . , . : : . . : , , ( 20-200 /, / (/) 2.5-25 , 3.5-35 , 24- 30-300 . , 24- > 1. 130/80 (125/75 , 1 /24 ). 1. ( ) - . 1-2 . - 30% 2 ( > 5.6 /). . 2. , . < 30//1.732 > 150 / , . 3. , , . 2 ( 123) . 1. 1. ( 123 ) (/)

> 1.0, > 1.3 /

< 1.7 /

< 2.5 /< 1.8 /,

2.5 /. , ( ), ; , . 2.5 / . 4 / , . 5 / . ( -3 ), , ). (> 5 /) . 2. : 10 = 20 = 5 = 40 = 40 = 80 . 2. 2 .

> 2.5 / < 5 /1.

5 /1. +

* . 5 / 2 ; .

100 / 50 60 -, ( 50 , , , , . 2 . , , . . : 20200 /. . , . . , . 1) , , 2) , 3) , 4) . / >150 /, 50% , . . , , 1.5 /. 2 () 1- . ( ) . ; . : / ? , , . ( ) ; ( 130/80 ) : ( , ) (, , ) 1 < 7.0% (53 /), 8.0% (64 /). ( ; ). < 6.7 /, 4.0 5.5 / 1 7.0% (53 /). . ( //) (100 )? ; . ( ) 13- , . 3 , (1 < 7.5% (58 /)) . ( 130/80 ) : , , , , . , ( )., , , : (/ ) 24- ; 24- ? . . (1 > 10% /-1 ) ( > 2.5/ , > 5 / ) . / , ( ) ( ). , . , , , , - , , . ( < 30 //1.732), (24 > 3.5 ) ( , , ). ( ) - . : . , , (, , -1 ). - - ; .. 1 , . . . 10 ( , ). , . - 10-200 . - . 5.5 / , 2 . 70 , , 50 2 , . 2 , (-Fenofibrate may reduce cardiovascular events in patients with type 2 diabetes, but there is no evidence of a beneficial effect on total mortality.). ( ) 2 . (-Primary prevention with low-dose aspirin appears to be less (and only marginally) effective in patients with type 2 diabetes than primary prevention in patients with other cardiovascular risk factors or secondary prevention in patients with cardiovascular disease. The effect may be confined to elderly individuals.). , , , , . 2 : . 2008;336:1306-8. 1. , , . : , , : . 2009;119(2):351-7. PMID: 190956222. , , . 10- - 2 . 2008;359(15):1577-89. PMID: 187840903. , , . 2 : : . 2009;32(1):193-203. PMID: 189459204. , , . - 2 . 2009;361(18):1736-47. PMID: 198507035. , , . , , . 2010;362(18):1675-85. PMID: 204277786. , , . : , , : . 2009;119(2):351-7. PMID: 19095622 : - : 00488 (023.32) 2012 1. -, 15.03.2012, .-.2. 4 .3. 2016 . -1 2 18.112010 - -1 () 2 ( , , , ) 2. , . , 1 6.5-7.0% (48-53 /) . . 1 7.0 % (53 /), . , 1 7.0% -1 . 1 1. .(-). . 1. - ( )

500-2000 21.52.0%

4-6 11.5-2.0%++++>98 %

10.514 21.52.0%++++> 98%

1015 21.01.5 %++++> 98%

( )

60-360 30.5-1.0 %++++>98%

0.5- 12 31.52.0 %++++> 98%

-

10010.5-1.0%

5020.5-1.0%

510.5-1.0%

15-4511.01.5%+++> 98%

5000-1500030.5%

(-). . , . , . , (-)_. (2-2.5 /). , , 500 / 500 / 2-2.5 /. , 10% . 150 / 0.5 / . ; , . , . , . , , , . , ( 6 , 10-14 , 15 , 320 . 1 1.52.0%.) 1 10% (86 /), (-); . . , . . . . - . . ( ?) . (10 ) 120 4 . . , . - -1 - ( ) , . -1 (--) . -1 . , - , , ( 1.5 /1% 1). , -1 . - -1 . ( 50% ). 1 7.0% (53 /) . . . . , . , . . , . () 5% . (510 /) . . , . , . , 2.5 , 15 /. - , . - 2 (-Alpha-glucosidase inhibitors have a significant effect on glycemic control and insulin levels, but no statistically significant effect on lipids and body weight. It is unclear whether alpha-glucosidase inhibitors influence mortality or morbidity in patients with type 2 diabetes.). , , , 2 . (-Rosiglitazone is not effective in improving patient-oriented outcomes such as mortality, morbidity, costs and health-related quality of life for type 2 diabetes mellitus. It appears to increase the occurrence of oedema and the risk of myocardial infarction.). -4 , , , -4 (-The use of DPP-4 inhibitors appears to result in a slight improvement in glycaemic control compared to placebo, but there are no data on patient-oriended outcomes such as health-related quality of life, diabetic complications and all-cause mortality, and there is insufficient evidence on the effectiveness of DPP-4 inhibitors as add-on drugs.). , (-Metformin lowers blood glucose as effectively as sulfonylureas, with the advantage of better weight control.). (-Acarbose may be more effective than placebo as adjunct therapy for patients with poorly controlled NIDDM.). -1 4 2 , (-1 ) (4 ) . . (-Incretin-based therapy with GLP-1 analogues or DPP4 inhibitors in adults with type 2 diabetes is moderately effective in improving glycaemic control, with greater reductions in postprandial glycaemia and favourable (GLP-1 analogues) or neutral (DPP4 inhibitors) effects on weight. Long-term efficacy and safety are under surveillance.). , , , , , , . 2 (-3): - . 2010 26;375(9733):2234-43. PMID: 20609969 , , , . - 2 : ( 10). 2008 ;155(4):712-7. PMID: 18371481: - : 00490 (023.034) 2012 1. -, 18.11.2010, .-.2. 3 .3. 2013 . 1 14.112010 . , . 1 . ( ) ( ). - ( ) . / , , - ( ). - , . , , . . (1 , ) - - , . 1 , . 1 7% (53 /), . 1 /. ( ) , 1 6.57.5% (4858 /) . - : 46 / 1.52 8(10) /. , . . () . 1 0.50.8(1.0) /. (0.20.6 /) ( ) . , . , (4060%) . ( ) . . 0.81.2 10 ; . , ( 1.5 ), . , 2 / . ( ) . 70 4050 . : 10 2 / 1 10 1 2 /. 100 24 - . , 24 30, - 3 /. , 60 24 , - 1.7 /. 20-30 , , . 12 24 , . 1 , ; / . 12-20 , ; / . 4-12 . , . ,