:

:
:

, ,

,
.

4 :
1 (1):
.
.
2 (2):

.
.
: , , , .
:

.


:
126 mg/dl 8

200 mg/dl.
24-
.
,

200 mg/dl, 2 75 g

.

,

.
.

< 100 mg/dl.

100 125 mg/dl
(Impaired Fasting Glucose, IFG).
140 mg/dl <200 mg/dl, 2
75 g
< 126 mg/dl,
() (Impaired Glucose Tolerance,
IGT). IFG IGT .

2
.


(
) 7-8%.
, 95% 2 5%
1.
(2,4% 1974, 3,1% 1990 7-8% ).

30 kg/m2


> 4 kg

/ ()

( 140/90 mmHg)

HDL < 35 mg/dl > 250 mg/dl

(
, )

,
45 .
,
3 .
.


2

10
:

2

( , , ,
)

25% IFG IGT
3-5 .

.
, ,
.
.

HbA1c

( )

( ) <180 mg/dl

7%
70-130 mg/dl

HbA1c HbA1c 4,06,0%.

1-2
.

, ,
, ( ),

.

, ,
,
, - HbA1c 7,0-7,5%.

,

, ,
,
.

:
o < 130/80 mmHg
o LDL < 100 mg/dl
< 70 mg/dl o
-

:
o HDL > 40 mg/dl > 50 mg/dl

o < 150
5 mg/dl



.
,

.

(75160 mg/ )
(
).

(75160 mg/ )

1 2
(10- >10%).
> 50 > 60

(

).

75 g/ .

 2

. HbA1c 3
. > 7%
.

( 1)
( 2).


.
( 3)
2.

 1. GLP-1 (1/2)

mg/

mg/

850/1000

500-3000

12 24

50/100

150-300

1.

2,5 20

12 24

2.

MR

30

30 120

1/2/3/4

16

3.

1.

0,5/1/2

1 16

2.

60/120/180

120 - 540

15 /30/45

15 - 45

DPP-4
GLP-1

DPP-4
GLP-1

DPP-4
GLP-1

DPP-4
GLP-1

 1. GLP-1 (2/2)

mg/

mg/

DPP-4
1.

100

100

2.

50

100

3.

(,
)

GLP-1

1.

5/10 g

10 20 g

45-60 min

2.

0,6/1,2/1,8 mg

0,6 1,8 mg

(

glargine.


detemir)

:
,
,

 2.

DPP-4

GLP-1

10

 3. 2

HbA1c 6,5 7,5 %

HbA1c 7,6 9,0 %

:
:

**

,
DPP-4,
, ,

( )
+

+ 2

+

+ 2
+

HbA1c > 9,0 %

(
)
+

=
=
DPP-4:
DPP-4
=
=
=

+ 2 /
3

(
)
+

* HbA1c<6,5%

**

1.
2.
3.

(
) +

(
) +

: bA1c > 7% .
1
HbA1c > 9%,

# : GLP-1

11

 1
1

.
( ,
) .
(basal) ()
. ()
() ,
10-16 .
(bolus)
(). ,
, ,
o .
. ,

kg .
4.

12

 4.

( )
Aspart
Glulisine
Lispro




(rDNA)
(aDNA)

(rDNA)
()

( )
Detemir
Glargine


30% 70%

30% (rDNA)
70%
40% 60%

50% 50%

25%
lispro 75% lispro
50%
lispro 50% lispro
30%
aspart

70%

aspart

()

10 min
10-20 min
0-15 min

1-3
0,5 1,5
1

3-5
3-4
3-4

3-5
3-4
3-4

30 -45 min
30 min

1-3
1-3

5-7
6-8

5-7
5-7

1
1,5

2-8
4-12

16-18
24

10-16
10-16

1-4
1-4

24
24

30 min

2-8

24

10-16

30-45 min

1-8

14-15

10-15

30 min

2-8

24

10-16

30 min

2-8

24

10-16

0-15 min

10-16

10-16

0-15 min

10-16

10-16

10 min

1 - 8

24

10-16

1 2

13


(basal)
(bolus) .

.

1 .
1
5.
5. 1

()
+

(3)
(
)

14

1. 1
-

1 90%

-
( 6):
:
, .
.
: ,
.
.

6. 1

(
)

(
)
+


()

()
+

(3)
(
)

15

2. 2
,

.
(>
300 mg/dl) ,
. .
2
, .
3 .
3 .

16

 2
1.

HbA1c 7%.
2. 2
2
.
.

.
:

2.1.

.
.

HbA1c>9%

.

.
( ).

2 .
HbA1c (
)
.
,
.

17

2.2.

.


.

.
,
HbA1c
.
.

2.3.


.
. HbA1c
.
,
0,3 /kg ,
.


.
,
.

.

18



.

.
.
2
.
2 ( 7).

19

20

1.

.
60-99 mg/dl, 100-129 mg/dl HbA1c <6%.
2.
.
.
Lispro Aspart
.
detemir
. glargine

.

.

21