. .

..


2: 8%
3 30

( )

()

2.

DCCT , UKPDS UKPDS
UKPDS-- DCCT EDIC STENO2
PROACTIVE ;

ADVANCE--ACCORD
ADVANCE
ACCORD--VADT
VADT--STENO



ADA 201
2012

HbA1c <7%
ADA:: A
ADA

HbA1c <7%
ADA: B

,
CVD

HbA1c <6.5%
ADA: C

HbA1c <8%
ADA: B

Diabetes Care 2012;35:Suppl.1


2
2 (
())
A 2010
A1C > 9%
()

A1c > 8.5%

( )

A1C < 8.5%

+ 1

+
TZD
MET +
GLP-1 DPP-4
SU GLIN

2-3
>7%

+
TZD
MET +
GLP-1 DPP-4
SU GLIN

+ +/-

2-3
>7%

A1c<8%

A1c<8%
A1c>8%

+
TZD + SU
MET +
GLP-1 DPP-4 2 + SU
GLP-1 DPP-4 + TZD
2-3
>7%

1.

2.

3.

DPP
DPP--4 ()

+ +

A1c>8%

2-3
>7%

- 50%
- >50% -
()

- 2/3
HbA1c
-


!!!

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

!!! !!!

Adapted from: Korytkowski M. Int J Obes 2002;26(Suppl 3):S13):S1-S7

...

A1 C >8,5%
140mg/dl
140mg/dl
220mg/dl
220mg/dl

200mg/dl
200mg/dl

:
:

Multivariate analysis of the risk factors for

severe hypoglycaemic events

Albumin:creatinine ratio
>300: HR 1.74
(95% CI: 1.372.21)

African American:
HR 1.43
(95% CI: 1.201.71)

Every 1 year increase in age:

HR 1.03
(95% CI: 1.021.05)

Women:
HR 1.21
(95% CI: 1.021.43)

BMI >30 kg/m2:

HR 0.65
(95% CI: 0.500.85)
BMI, body mass index
Miller et al. BMJ 2010;340:b5444

stress (,
(,
, ,
)

( )+

:
:

HbA1c

IDF Global Guideline for Type 2 Diabetes, 2005

-Ins.Glargine(LANTUS)
-Ins.Detemir (LEVEMIR)
)
-Ins. Protaphane
-Ins.Humulin NPH

24

LANTUS

2-4h

24h

LEVEMIR

1-2 h

18--24 h
18

HUMULIN
NPH
PROTAPHANE

2 -4 h

6 -8 h

12--15h
12

 2
detemir
0.4 U/kg

(mg/kg/min)

glargine

0.8 U/kg

3.0
2.5
2.0
1.5
1.0
0.5
0
0

10 12 14 16 18 20 22

24

(h)

Klein O. et al. Diabetes Obesity & Metabolism 2007;9:290-9

24
2

King AB, et al. Diabetes, Obesity and Metabolism 2009;11:6971


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

 (Levemir
(Levemir Lantus
Lantus))

2
A HbA1c - (HbA1c
<7%)

( , , )

( Levemir
Levemir))



24
24
(p<0,001)
20
2

300

15
200

10
100

0
6

10

14

18

0
22

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

(mmol/l)

(mg/dl)

400

Baseline
After Insulin
Glucose Disposal
% of Matched Control Values

100

87
80

80
60

67
57

53
40

40
20
0
Scarlett

Andrews

Garvey

Scarlett, et al. Diabetes Care.

Care. 1982;5:3531982;5:353-363; Andrews, et al. Diabetes
Diabetes.. 1984;33:6341984;33:634-642; Garvey, et al. Diabetes
Diabetes..
1985;34:222--234.
1985;34:222

08:00

DPP-4

14:00

20:00

24:00

detemir
glargine
Jarvinen et al, Ann. Int. Med. 130: 389389-96, 1999

 HbA1c
+ ;

A1c
Glargine

A1c

Eliaschewitz (2006)

9.1

7.7

1.4

Fritsche (2003)

9.1

7.8

1.3

Massi (2003)

9.0

8.5

0.5

Riddle (2003)

8.6

7.0

1.6

Rosenstock (2001)

8.6
8.6-9.1

8.2

Yki--Jarvinen (2006)
Yki

9.1

7.2

1.9

Yokoyama (2006)

7.2

6.6

0.6

Hermansen 2006

8.6

6.6

Phyllis--Tsimikas (2006)
Phyllis

9.1

7.5

1.6

7.2

6.6-8.5

0.4

Detemir

0.4-2.0

 (
( 7%)

Glargine + SU + MET (n = 367)

8.6

7.0

M. Riddle et al
Diabetes Care 2003;26:30802003;26:3080-3086

NPH + SU + MET (n = 389

8.6

7.0

M. Riddle et al
Diabetes Care 2003;26:30802003;26:3080-3086

Glargine +SU + MET (n = 177

8.8

7.2

Glargine + MET (n = 61)

9.5

7.1

NPH + MET (n = 49)

Glarine + SU + MET (n = 104)

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

(n
(n = 2325 )
9.6 8,8 %7.2
HbA1C
7,0%

60 U
U
8.8 7.1

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)

6.8

K. Hermansen et al
Diabetes Care 2006;29:12692006;29:1269-1274

8.5

6.6

K. Hermansen et al
Diabetes Care 2006;29:12692006;29:1269-1274

8.7

6.8

H. Yki Jarvinen et al
Diabetes Care 2007;30:12007;30:1-6

7.2

J. Ronenstock et al
Diabetologia 2008;51:4082008;51:408-416

8.6
10

H. Yki Jarvinen et al
Diabetologia 2006;494422006;49442-451

8.6

8.6

Glargine x 1 + SU + MET
(n = 291)

H. Yki Jarvinen et al
Diabetologia 2006;494422006;49442-451

J. Ronenstock et al
Diabetologia 2008;51:4082008;51:408-416

7.1
9

HbA1c (%)

.


(NPH,
(NPH, Glargine Detemir)

Detemir Glargine

!!!!