Transcript
1 0 5 6 9 8
1 0 8 2 3 4
1 0 9 5 2 4
1 0 9 3 7 3
1 0 8 0 3 1
1 0 7 6 6 3
1 0 7 0 8 9
1 0 5 9 6 1
1 1 0 2 0 2
1 1 4 2 0 7
1 1 6 6 0 5
1 2 2 0 0 1
1 2 8 3 3 3
1 3 4 4 9 4
1 3 9 4 9 6
1 5 3 2 7 6
1 7 5 7 5 5
1 8 7 6 6 8
1 9 8 9 5 5
2 1 1 4 0 0
2 2 3 7 9 0
2 4 0 0 1 9
2 5 4 5 9 3
0
50000
100000
150000
200000
250000
300000
- 387
40 - 59
. - 55 773
–
«»
- ,
2-3
- HbA1c
2-4
1912 , ,
(-NH2) , ( ).
/ , ().
- b1
, " "
1
,
- 2
- 10
- 20
, %
IV.
,
IV
β-, - , β-
VI β- (90%) –
-
1
(HLA) – 6 , , ,
– DR3, DR4, DW3, DW4, B8, B15, DQ
– DQB1, B7, D21
-
4%
β- ( 4) .
( ) «»
β- (GADA - GAD 65, IA-2A - IA-2, ICA - , IAA - , CD-38 – –
REG – )
1
LADA
Chan JM et al. Diabetes Care 1994; 17: 961–969.
27,983 men
Després JP et al, 2001; Pouliot MC et al, 2004
300
200
100
0
MRI: magnetic resonance imaging
2
- 2
2
-2
,
-
())
,
(«»)
( )
HbA1c – 2011
, ,
FINDRISK)
,
«» :
, /
HbA1
, ,
, –
3
2010 , ,
, ( )
,
HbA1c ( , 1 , 2 , 3 )
,
, – 4%
GLUT 1,2
4-
2- 6,1 / ( 7,0 /),
2- () 11,1 /.
() ;
1 ( 2- 6,5%
.
22.5
.
.
C HBA1C 1%
UKPDS Group. Diabetes Res 1990; 13: 1–11.
The Hypertension in Diabetes Study Group. J Hypertens 1993; 11: 309–317..
1921 .
11.1.1922 -
(1891-1941) . 1916 ., . , . …
– - – . , . , .
, . -
-, , " " -.
- ……..
07.00 14.00 23.0019.00 07.00 14.00 23.0019.00
07.00 13.00 23.0019.00
L /
,
1,7 /)
3 .
2-
I.
, 02.07.2013 764
)
‹<10%)
20 40 ),
,
1,0–0,8 / ,
3 , –
1,5–2,0
(<30
4-5 , , ,
.
,
, ,
,
()
14 /
, , -
.
,
, – -
() ()
150
.
-1-2,0% /
/
-1-1,5% /
-0,5-1,4% /
-0,5-0,8% /
DPP-4
GLP-1
GLP-1 ,
-1,0-2,0% /
-0,5-1,0% /
???? /???
???? /???
-1,5-2,5% /
,
, ,
: 1500 –
– 3000
???
• HbA1C
• • • •
5 «+»
() 2 IFG*
50
100
150
200
250
300
350
50
100
150
200
250
Years of Diabetes
Adapted from Type 2 Diabetes BASICS. International Diabetes Center; 2000.
N
3 .
2-
)
2-3
)
60 –
30
120 (2 60 )
< 30 /
1. KAT-
5. - ,
-
-
SGLT-2
Sodium-glucose cotransporter type 2 – –
SGLT-2
– : , , , .
1 6,5 – 8,0%, ,
:
<5
2 <10 /
-4 (, )
,
EP Joselin, 1927
•180 • •Na- SGLT2 90% , SGLT1 - 10%
Mather, A & Pollock, C. Kidney International. 2011;79:S1-S6. Chao EC, et al. Nat Rev Drug Discovery. 2010;9:551-559.
SGLT2 Glucose
Majority of
glucose is
Minimal
SGLT2
Glucose
Dapagliflozin
SGLT2
Dapagliflozin
….
– ...
– Salsalate
– Tresiba Rysodeg –+….
:
- 2 *
>10,0 >11,1 >11,1 >12,2
:
- 2 *
>6,7 >7,8 >7,8 >8,9
<10,0 <11,1 <11,1 <12,2
- 2 * ( )
<6,7 <7,8 <7,8 <8,9
* - : 75 300 3-5
.
1912 , ,
(-NH2) , ( ).
/ , ().
- b1
0
50
100
150
200
250
300
350
400
450
500
4 5 6 7 8 9 10 11 12 13 14
G lu
co se
n = 1441, r = 0.81
1 0 8 2 3 4
1 0 9 5 2 4
1 0 9 3 7 3
1 0 8 0 3 1
1 0 7 6 6 3
1 0 7 0 8 9
1 0 5 9 6 1
1 1 0 2 0 2
1 1 4 2 0 7
1 1 6 6 0 5
1 2 2 0 0 1
1 2 8 3 3 3
1 3 4 4 9 4
1 3 9 4 9 6
1 5 3 2 7 6
1 7 5 7 5 5
1 8 7 6 6 8
1 9 8 9 5 5
2 1 1 4 0 0
2 2 3 7 9 0
2 4 0 0 1 9
2 5 4 5 9 3
0
50000
100000
150000
200000
250000
300000
- 387
40 - 59
. - 55 773
–
«»
- ,
2-3
- HbA1c
2-4
1912 , ,
(-NH2) , ( ).
/ , ().
- b1
, " "
1
,
- 2
- 10
- 20
, %
IV.
,
IV
β-, - , β-
VI β- (90%) –
-
1
(HLA) – 6 , , ,
– DR3, DR4, DW3, DW4, B8, B15, DQ
– DQB1, B7, D21
-
4%
β- ( 4) .
( ) «»
β- (GADA - GAD 65, IA-2A - IA-2, ICA - , IAA - , CD-38 – –
REG – )
1
LADA
Chan JM et al. Diabetes Care 1994; 17: 961–969.
27,983 men
Després JP et al, 2001; Pouliot MC et al, 2004
300
200
100
0
MRI: magnetic resonance imaging
2
- 2
2
-2
,
-
())
,
(«»)
( )
HbA1c – 2011
, ,
FINDRISK)
,
«» :
, /
HbA1
, ,
, –
3
2010 , ,
, ( )
,
HbA1c ( , 1 , 2 , 3 )
,
, – 4%
GLUT 1,2
4-
2- 6,1 / ( 7,0 /),
2- () 11,1 /.
() ;
1 ( 2- 6,5%
.
22.5
.
.
C HBA1C 1%
UKPDS Group. Diabetes Res 1990; 13: 1–11.
The Hypertension in Diabetes Study Group. J Hypertens 1993; 11: 309–317..
1921 .
11.1.1922 -
(1891-1941) . 1916 ., . , . …
– - – . , . , .
, . -
-, , " " -.
- ……..
07.00 14.00 23.0019.00 07.00 14.00 23.0019.00
07.00 13.00 23.0019.00
L /
,
1,7 /)
3 .
2-
I.
, 02.07.2013 764
)
‹<10%)
20 40 ),
,
1,0–0,8 / ,
3 , –
1,5–2,0
(<30
4-5 , , ,
.
,
, ,
,
()
14 /
, , -
.
,
, – -
() ()
150
.
-1-2,0% /
/
-1-1,5% /
-0,5-1,4% /
-0,5-0,8% /
DPP-4
GLP-1
GLP-1 ,
-1,0-2,0% /
-0,5-1,0% /
???? /???
???? /???
-1,5-2,5% /
,
, ,
: 1500 –
– 3000
???
• HbA1C
• • • •
5 «+»
() 2 IFG*
50
100
150
200
250
300
350
50
100
150
200
250
Years of Diabetes
Adapted from Type 2 Diabetes BASICS. International Diabetes Center; 2000.
N
3 .
2-
)
2-3
)
60 –
30
120 (2 60 )
< 30 /
1. KAT-
5. - ,
-
-
SGLT-2
Sodium-glucose cotransporter type 2 – –
SGLT-2
– : , , , .
1 6,5 – 8,0%, ,
:
<5
2 <10 /
-4 (, )
,
EP Joselin, 1927
•180 • •Na- SGLT2 90% , SGLT1 - 10%
Mather, A & Pollock, C. Kidney International. 2011;79:S1-S6. Chao EC, et al. Nat Rev Drug Discovery. 2010;9:551-559.
SGLT2 Glucose
Majority of
glucose is
Minimal
SGLT2
Glucose
Dapagliflozin
SGLT2
Dapagliflozin
….
– ...
– Salsalate
– Tresiba Rysodeg –+….
:
- 2 *
>10,0 >11,1 >11,1 >12,2
:
- 2 *
>6,7 >7,8 >7,8 >8,9
<10,0 <11,1 <11,1 <12,2
- 2 * ( )
<6,7 <7,8 <7,8 <8,9
* - : 75 300 3-5
.
1912 , ,
(-NH2) , ( ).
/ , ().
- b1
0
50
100
150
200
250
300
350
400
450
500
4 5 6 7 8 9 10 11 12 13 14
G lu
co se
n = 1441, r = 0.81