....................................................................................................... ............................................................. ......................................................... ............................................................................ ......................................... ............................................................................................

CONT EN T S

2017

1

182122834212812

2

1723221kcal3

1

1

1 2 http://www.med.or.jp/jma/diabetes/form/000465.html

3

1GLP-123

12

1 http://www.med.or.jp/jma/diabetes/form/000465.html

3

HbA1chttp://www.nittokyo.or.jp/patient/goods/index.html

4

11

126mg/dL75gOGTT2200mg/dL200mg/dLHbA1c6.5

HbA1c

HbA1c6.5HbA1c

HbA1c

HbA1c6.52

110125mg/dLOGTT2140199mg/dL

2

4,000g

HbA1c85cm90cm

3

5

BMIkg/mm25192211GAD

21

1HbA1c8.7GAD

1

HbA1c

HbA1c

HbA1c

HbA1c

HbA1c

HbA1c

1

..... .....

36HbA1c

126mg/dLOGTT 2200mg/dL200mg/dL HbA1c6.5%

HbA1cHbA1c

554942012

6

4

300mg/dL

3

1112

12

GDMgestationaldiabetesmellitus

21

7

1

2

2

2016-20172016277

6.0 7.0 8.0

HbA1c%

1 2 3

4

1

2HbA1c7%130mg/dL2180mg/dL

34

23122

2ADL3

8

3HbA1c

2016-201720169816

ADLADL

1

8.07.0%

8.57.5

ADL ADL

ADL

ADL

3

7.07.0 8.02

7.56.5

6575

8.07.0

75

S U

1ADLADLIADLhttp://www.jpn-geriat-soc.or.jp/

27.0%6.0%8.0%III8.5%

365

9

1

.................................... BMI.22............................................130/80mmHg125/75mmHgLDL............... 120mg/dL100mg/dLHDL..................... 40mg/dL............ 150mg/dLnon-HDL...... 150mg/dL130mg/dL

LDLFriedewald LDL HDL /5 400mg/dLnon-HDLHDL150mg/dL130mg/dL

10

780kcal165060%2025%

12345

65%

2530kcal 3035kcal 35kcal

kgmm22

1kg

1

11

3511005010012050206023

SU

250mg/dL

2

4

4

12

21

53

eGFR

2

HbA1c7823

eGFRmL//1.73m23030454560NSAIDs75http://www.fa.kyorin.co.jp/jds/uploads/recommendation_metformin.pdf

1115mg

SUSU

DPP-4SU

52

13

dipeptidylpeptidase-4sodium-glucoseco-transporter-2

#1#2#3#4

2

#3,#4250,500mg

1530mg OD

DPP-4 11212.5,25,50,100mg

#450mg#46.2512.525mg5mg20mg100mg2.55mg

150,100mg12.5,25mg

#1,#3,#40.513mg#2,#320,40mg

ODHA)

#330,90mg

#45,10mg0.25,0.5mg

-

#350,100mg#3,#40.2,0.3mg25,50,75mg

(OD)(OD)OD

SGLT2 25,50mg5,10mg20mg

2.5,5mg100mg10,25mg

14

-

12kg/

1

250mg/dL or350mg/dL or

BMI22BMI25

HbA1c7.0%,130mg/dL

, 2180mg/dL

23

GLP-1

DPP-4 SU - SGLT2

SU

yes

yes

yes

no

no

no

no

yes

5

15

344

HbA1c0.5/

3

111.5L

SMBGself-monitoringofbloodglucose1

65SUhttp://www.fa.kyorin.co.jp/jds/uploads/photos/797.pdf

SGLT2756574ADLhttp://www.fa.kyorin.co.jp/jds/uploads/recommendation_SGLT2.pdf

16

35

30 58 RR

1824 3050702550

30 1824 30R3/7

42

30or 1824 NNN

or 2442 XRBS

3

4

1 or or or or

2 or or or

3

4 or

2250mg/dL350mg/dL2363

17

1

21kg0.1SMBG

12

SMBG7113

2cm

18

24 110.9mg/1

8 121020g/2

15 111020g/3

12mg/

10.75mg/

5GLP-1

10.9mg11110.3mg10.3mg)

26015g121110g

31110g11115g11120g

GLP-1DPP-4http://www.fa.kyorin.co.jp/jds/uploads/photos/797.pdf

GLP-11121

SU

112

GLP-155

19

1/612

1/36

1/12

1/21

GFReGFR

30.81.0g/kg/6.0g/0.60.8g/kg/

130/80mmHg

ACEIIARBGFR

1

2

20

mg/gCr

g/gCr

GFReGFRmL//1.73m2

1 30 302

2 302993 30

3 300

0.5304

4 5 30

5

6 1

115

2GFR60mL//1.73m2CKD

3

4GFR60mL//1.73m2GFReGFR

5GFR30mL//1.73m2

201457529-5342014

GFR

ED

NSAIDs2

3

21

4

CT

CTMRI

5

ED

22

6

ACEARBCaACEARBCa3

7

130mmHg80mmHg

5mmHg125/75mmHg

9

23

HPhttp://www.mhlw.go.jp/stf/houdou/0000121935.html

28324

21

NTT

JCHO

NTT

NTT

113-86212-28-16TEL 03-3942-8181FAX 03-3946-2684http://www.med.or.jp/

3

2017201612