:

.
.
. &
-
(
) (evidence based
medicine)
. ,

.
2006
.
1) ADA EASD 2006

Statement ADA & EASD 2006,2008

+ Metformin

-
*

+ +/-

Diabetes Care 2006; 29 :1963 -72

Consesus Statement ADA & EASD 2008. Diab. Care 2008; 31: 1-3

2006, ADA EASD, , ,

,
, (Guidelines)
.

.
,
ADA EASD 2006 2008 :
-
- 2
- 2 (
). ,
.

- A1C<7%

.
2) ADA EASD 2009

Consensus Statement ADA EASD 2009
1: ( )
:
Lifestyle
+
Metformin

Lifestyle

Lifestyle + Metformin
+
Basal Insulin

+
Metformin
+
Intensive
Insulin

Lifestyle + Metformin
+
Sulfonylurea

2: ( )
Lifestyle + Metformin
+ Pioglitazone

/.

Lifestyle + Metformin
+

GLP-1


/

Lifestyle +
Metformin
+
Pioglitazone
+
Sulfonylurea*
Lifestyle +
Metformin
+
Basal insulin

Nathan et al, Diabetologia, on line 2008, DOI. 10.1007/s00125-008-1157-y

) 1 (
)
.
)
( )
.
) (
) .
drug effect class effect TZDs.
) ( )
.
) DPP-IV

.
)

.

3) NICE 2009

Guidelines
NICE 2009
1 : Metformin +
A1C> 6,5%
2 : - Sulfonylurea
- DPP-4 TZDs
A1C 7,5%
3 : Sulfonylurea + Metformin
- DPP-4 TZDs
GLP-1
- (NPH
)
( HbA1c 9.0%)
BMJ 2009;338:1668

3, ,
, National Institute for Health and Clinical Excellence
(NICE) . .
NICE
)
(
).
)
() . 2 DPPIV () 3 .
)
.
,
.
) ( )

( .
).
,
.
, NICE
2008,
,
(
) .
4) AACE 2009

AACE October 2009

.

.
,


.
.
DPP-4
.

AACE :
, HbA1c,
(A1C < 7,5, A1C 7,5 - 9%, A1C > 9%)

HbA1C > 7,6%
TZDs
NAFLD
HbA1C > 9%
.

5) 2011


2
HbA1c > 8.5%
(
)

HbA1c 8.5%

&
+

+2

&
+

HbA1c
2- 3

HbA1c
2- 3

HbA1c <8.5%

&
+

+2

+
3

2011

HbA1c
2- 3

HbA1c >9%
( )

&
+

HbA1c >8.5%

&
+

2011 ( )
. ,
.

:
,
1C
(A1C 8,5, A1C > 8,5%, A1C > 9% )
( ) 2
,
. 2
( DPP-4, GLP-1)
H A1C > 8,5%
H A1C
> 9% .

6) ADA EASD 2012

ADA,EASD 2012 T2DM Anti-hyperglycemic Therapy: General Recommendations

Position Statement

Diabetes Care, Diabetologia. 19

April 2012 [Epub ahead of print]

2012
(position statement) ADA EASD.

Diabetes Care
Diabetologia 2012.

.

:
.

(patient centered approach) .
()
.
.

.
2 5 (
, , DPP-4 , GLP-1 , ).

(, , ,
, ).


,

( )
(Lifestyle GLP -1 DPP 4
?)
(,
Preconditioning, (?) )

, ,
(
)
,
()

- (,
, , , ,
, ).
ADA EASD
,


.

1. D. Nathan, J. Buse, M. Davidson et al. Management of Hyperglycemia in

Type 2 Diabetes: A Consensus Algorithm for the Initiation and Adjustment of
Therapy: A consensus statement from the American Diabetes Association and the
European Association for the Study of Diabetes Diabetes Care 2006;29:1963-72.
2. DM . Nathan, JB . Buse, MB. Davidson et al. ADA/EASD consensus statement
and algorithm for the treatment of Type 2 diabetes. Diabetologia 2009;52:17-30.
3. G . Schernthaner, AH Barnett, DG Betteridge et al: Is the ADA /EASD algorithm
for the management of type 2 diabetes (2009) based on evidence or opinion? A
critical analysis. Diabetologia 2010;53:1258 1269
4. NICE. Type 2 Diabetes: The management of type 2 diabetes: NICE clinical
guidelines. National Institute for Health and Clinical Excellence 2009
5. AI. Adler , EJ. Shaw, T. Stokes et al. Newer agents for blood glucose control in
type 2 diabetes: summary of NICE guidance BMJ 2009;338: b1668
6. HN Rodbard, PS Jellinger, JA Davidson et al: Statemenet by AACE/ACE
consensus panel on type two diabetes mellitus: an algorithm for glycemic control:
End. Pract 2009;15:540-559
7. .
2.
2011, . 23-27
8. . : . : .
2012.
9. Si. Inzucchi, R. Bergenstal, J. Buse et al. Management of Hyperglycemia in
Type 2 Diabetes: A Patient-Centered Approach: Position Statement of the American
Diabetes Association (ADA) and the European Association for the Study of Diabetes
(EASD) Diabetes Care 2012; 35: 1364 1379