25-28 2013

1
2
3
4
5
6
7
8

,
,
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-

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-

ADA, EASD 2012

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1
2
3
4
5
6
7
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/

HbA1c

DeFronzo R, Diabetes 2009; 58:773

 DPP-4

()

,

&

GLP-1

-
&
-

GLP-1 ()

-,

- &

bA1C (%)

&

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.
.
.
.

1.0-2.0

.
.
.

.
(GFR <30ml/min).

0.5-0.8

.
.

.
(GFR <25ml/min).

1.0-2.0

.
.

.
.
(GFR <30ml/min).

0.5-1.5

.
.
(GFR <15ml/min).

1.
2. MR
3.

1.
2.

0.5-1.4

.
.

DPP-4
1.
2.
3.

0.5-0.8

.
.

GLP-1
1.
2.

0.5-1.0

.
.

. . .
. .
.

, (GFR <5ml/min).
.
GFR <50ml/min
, ,
25mg
GFR <30ml/min.
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.
:
GFR <50ml/min ( GFR 50-30ml/min 5
g), GFR <60ml/min).

,
, ,

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2


10-15 , ( 4 )
2011

 2011, 2013

 2,
2013

 2, 50 , 1700 mg
5 ,

: (),

: 31.2 kg/m2
:
HbA1C: 7.6%, Glu: 137 mg/dl, Ur: 35 mg/dl, cr: 0.8 mg/dl,
SGOT: 80 IU/l, SGPT: 65 IU/l,
TChol: 255 mg/dl, HDL: 38 mg/dl, LDL: 110 mg/dl, TG: 165
mg/dl

12/3/2014

150

167

147

5
12/3/2014

140
160

110

165

125
175

1.
2.
3.
4.

&

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2. (2550 mg, 1x3):
7.6%
<7%
3.

4. :
5.

: ,
,

2011

20%
10%

HbA 1C vs placebo (%)

30%

Garber AJ et al. Am J Med 1997; 103:491497

(?)

 2, 60 , , 2000 mg
12
: 33.2 kg/m2
. .:
:
HbA1C: 8.2%, Glu: 177 mg/dl, Ur: 31 mg/dl, cr: 0.9 mg/dl

12/3/2014

150

165

149 193

177 190

12/3/2014

230
205

205

220

215

1.
2.
3.
4.
5.

&



GLP-1
DPP-4

& : ,

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(1x3):

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3.

,
4. GLP-1: ,
,
5. DPP-4: ,
,

- (?)

 2, 78
1700 mg 10

:
HbA1C: 8.2%, Glu: 137 mg/dl, Ur: 31
mg/dl, cr: 0.9 mg/dl

:

12/3/2014

130

105

193

117 190

118

220

12/3/2014

230
205

145

1.
2.
3.
4.
5.

GLP-1
DPP-4

1-30 min

- (?)

 , 60 , ,
Glu : 170 mg/dl HbA1C: 8.7%,
.

.
:
:
: 30.2 kg/m2

12/3/2014

1.
2.
3.
4.

1

,
DPP-4
,

 2013

1. :
,
2. , : , HbA1c >
8.5%
3. , , DPP-4:
, ,
, ,
4. , , :

 :
, pH
ATP +





,

:

+

,



:

-
5

 , 43 , ,

12, :
2000 mg
120 mg

: 40 kg/m2
HbA1C: 7.7%, Glu: 124 mg/dl

12/3/2014

140

135

193

117 190

218

220

12/3/2014

230
205

195

1.
2.
3.
4.
5.

GLP-1
DPP-4

& : ,

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2. :

3. GLP-1: ,

4. DPP-4: ,

5. :

 2013

- (?)