2

. Md Phd

20111

2

3

2
* HbA1c
>7.5%2
USD (Euros)


20111

20301

Belgium, France, Germany, Italy, Netherlands, Spain, Sweden, UK.

Exchange rate at 0.7 Euros per 1 USD (2011)
1. IDF. Diabetes Atlas 5th Ed. 2011; 2. Liebl et al. Diabetologia 2002;45:S238; 3. IDF. Diabetes Atlas 3rd Ed. 2006

126
(mg/dl)

100

()

20

10

10

20

30

Adapted from Bergenstal RM, et al. Diabetes mellitus, carbohydrate metabolism and lipid disorders. In Endocrinology. 4th ed. 2001.

 1

position statement EASD &
ADA (2012) 2013
2
:
) 1
) 2
) 3
)

Inzucchi and Associates. 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 Publish Ahead of Print, published on line April 19, 2012

 2013

O !

A. Rubino, Journal compilation 2007 Diabetes UK. Diabetic Medicine, 24, 4121418


?
)
10U/ 0.2U/Kgr 24
)
Hba1c ~
2%
)

.
)
.
) .

stress (,
, ,
)

Ligthelm J. R. et al., 2012. JAGS 60:15641570, The American Geriatrics Society


ADA/EASD
:

10 U/

0,2 U/Kg/24

2 U 3 ,

(70-130 mg/dl)

Nathan DM, et al. Diabetes Care 2006;29:1963-1972

: 10

0,2 /Kg

2 3
(70-130
mg/dl)
Nathan DM, et al. Diabetes Care 29:1963-1972, 2006

 (Levemir Lantus)
2

A HbA1c -
(HbA1c <7%)
(
)

( , , )
(
Levemir)



24
400
20
2

300

15
200

10
100

0
6

10

14

18

(mmol/l)

(mg/dl)

24
(p<0,001)

0
22

( )

6
Polonsky K et al. N Engl J Med 1988;318:1231-9


12.0

FPG
(mmol/L)

FPG
(mg/dL)

11.0

198

10.0
9.0

216

180

FPG

162

8.0

144

7.0

126

6.0

108

5.0

90

4.0

72

3.0
2.0
1.0

54

36
18

1 2 3

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

1. Sommerfield et al. Diabetes Care 2004; 27:23352340.

2. Cukierman-Yaffe et al. Diabetes Care 2009; 32:2216.

3. Morley. Clin Geriatr Med 2008; 24:395-405.


12.0
11.0

FPG
(mg/dL)

FPG
(mmol/L)

198

10.0
9.0

216

180

FPG

162

8.0

144

7.0

126

6.0

108

5.0

90

4.0

72

3.0
2.0

54

36

1.0

18
1 2 3

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

1. Sommerfield et al. Diabetes Care 2004; 27:23352340.

2. Cukierman-Yaffe et al. Diabetes Care 2009; 32:2216.

3. Morley. Clin Geriatr Med 2008; 24:395-405.


12.0

FPG
(mg/dL)

FPG
(mmol/L)

11.0

198

10.0
9.0

216

180

FPG

162

8.0

144

7.0

126

6.0

108

5.0

90

4.0

72

3.0
2.0
1.0

54

36
18

1 2 3

9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30

 NPH glargine

Study 1450, Heise et al. 2004.

 ( 7%)

Glargine + SU + MET (n = 367)

8.6

7.0

M. Riddle et al
Diabetes Care 2003;26:3080-3086

NPH + SU + MET (n = 389

8.6

7.0

M. Riddle et al
Diabetes Care 2003;26:3080-3086

Glargine +SU + MET (n = 177

8.8

7.2

Glargine + MET (n = 61)

9.5

7.1

H. U. Janka et al
Diabetes Care 2005;8:254 - 259

(n = 2325 )
9.6
7.2 7,0%
HbA1C
8,8 %
Glarine + SU + MET (n = 104) 60 U
8.8
7.1
NPH + MET (n = 49)

Determix x 2 + SU + MET
(n = 237)
NPH X 2 + SU + MET (n = 238)
Glargine + SU + MET (n = 121)
Determix x 1 2 + SU + MET
(n = 291)
Glargine x 1 + SU + MET
(n = 291)

H. Yki Jarvinen et al
Diabetologia 2006;49442-451

8.6

6.8

K. Hermansen et al
Diabetes Care 2006;29:1269-1274

8.5

6.6

K. Hermansen et al
Diabetes Care 2006;29:1269-1274

8.7

6.8

H. Yki Jarvinen et al
Diabetes Care 2007;30:1-6

8.6

7.2

J. Ronenstock et al
Diabetologia 2008;51:408-416

8.6
10

H. Yki Jarvinen et al
Diabetologia 2006;49442-451

J. Ronenstock et al
Diabetologia 2008;51:408-416

7.1
9

HbA1c (%)

) StepWise
) Basal bolus
)
)


12
(stent ),
,
HbA1c= 7.8%, BMI=31 k/m2
4.00 .
17.30 .
(4 ),
, 11.00 .
14.00 . 22.00 .

30
6 mg
1000 mgx2,

(10.00)

(16.00)

(22.00)

96

135

236

160

105

139

259

161

101

123

264

165

109

122

215

158

(10.00)

(16.00)

(22.00)

98

125

: 3

198

162

100

130

: 3

210

159

97

120

: 5

180

169

110

128

: 8

140

168

3 mgr

:
FBG 90126 mg/dl HbA1c 7%
FBG PPBG >160
mg/dl

1. Woerle H. Arch Intern Med 2004;164:162732

2. Monnier L and Colette C. Diabetes Metab 2006;32 (1):7-13

Liebl 2009

Conclusion: Early achievement of targets for glycaemic control may be important to reduce long-term risk in
people with diabetes, but treatment should be tailored to individual need.

Davidson MB Diab Care 2005;28:494-495


;


. 1

.2

24
1,
HbA1c .
1.
2.

Monnier L. Diabetes Care 2002;25:73741.

Monnier l & Colette C. Diabetic Med 2006;32:7-13.





10%


(Aspart/Glulisine/Lispro)

1
1

( )
0

10 12 14 16 18 20 22 24
(h)

STEPwise NovoRapid

2
3

HbA1c >7%

4U

HbA1c >7%

4U
3
4U
2

Pfutzner et al. 2009

Slide no 42

STEPwise NovoRapid

3
100

76,7 77,2

90

(%)

80
70
60
50
40
30

19,2

20

17,3

4,2 5,5

10
0

24

36

ExtraSTEP
SimpleSTEP
Meneghini et al. Diabetes 2010;59(Suppl 1.):A199 and Data on File

Slide no 43

) 30%
) 40%
) 50%
) 60%
) 70%

50%

(
)



.


basal-bolus
80 kg

= 80 kg x

0.5
U/kg

= 40 U

=
=

40 U x
40 U x

50%
50%

= 20 U
= 20 U

20 U x

1/3

= 6U

20 U x

1/3

= 7U

20 U x

1/3

= 7U



:
)

 12 1
.

 1500

1500
.
1

.

 1800

1800
.
1

.

43

41
49

59

47
51

20

40

60

80

23

48
54
49

20

40

60

: 2 (n=1971)

80

( )



:

( ) !
Haak T et al. Diabetes Obes Metab 2005;7:56-64
Raslova K et al. Diabetes Res Clin Pract 2004;66:193-201

1,2

1. Haak T et al. Diabetes Obes Metab 2005;7:56-64

2. Raslova K et al. Diabetes Res Clin Pract 2004;66:193-201

1. Haak T et al. Diabetes Obes Metab 2005;7:56-64

2. Raslova K et al. Diabetes Res Clin Pract 2004;66:193-201

Curr Med Res Opin. 2011 Nov;27 Suppl 3:13-20.


.

Dr. Elliot Joslin
( Joslin Diabetes Center)