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1、main/0609_new17/11/06DiabetesGlycaemiccontrolintype2diabetesSearchdateJune2005AmaryllisCampbellQUESTIONSWhataretheeffectsofinterventionsinadultswithtype2diabetes?................3INTERVENTIONSINTERVENTIONSINADULTSInsulindeliveredbycontinuoussubcutaneousBeneficialinfusion......................14Met
2、formin(comparedwithdietaloneorplacebo).......................3UnlikelytobebeneficialSulphonylureas(reduceHbA1ccomparedInsulincomparedwithsulphonylureasaswithplaceboordietalone;newerinitialtreatment(noaddedbenefitandwithsulphonylureasreducehypoglycaemiamorehypoglycaemicepisodesandmorecomparedwithol
3、dersulphonylureas)...5weightgain)....................14LikelytobebeneficialTobecoveredinfutureupdatesEducation(comparedwithusualcare).....7AcarboseIntensivetreatmentprogrammes(comparedInsulinplusoralhypoglycaemicdrugswithusualcare)..................9ThiazolidinedionesMeglitinides(nateglinide,repag
4、linide)....10CoveredelsewhereinClinicalEvidenceTradeoffbetweenbenefitsandharmsGlycaemiccontrolintype1diabetes,p01Combinedoraldrugtreatment(comparedPreventionofcardiovasculareventsinwithmonotherapy)...............11diabetes,p01Insulin(comparedwithcontinuationoforaldrugtreatmentwhereHbA1cisSeeglossa
5、ryinadequatelycontrolled)...........14UnknowneffectivenessDifferentfrequenciesofselfbloodglucosemonitoring.....................16KeyMessages?Diabetesmellitusisnowseenasaprogressivedisorderofglucosemetabolism,affectingabout5%ofthepopulationworldwide,over85%ofwhomhavetype2diabetes.Type2diabetesmayo
6、ccurwithobesity,hypertensionanddyslipidaemia(themetabolicsyndrome),whicharepowerfulpredictorsofcardiovasculardisease.Bloodglucoselevelsriseprogressivelyovertimeinpeoplewithtype2diabetesregardlessoftreatment,causingmicrovascularandmacrovascularcomplications.?Mostpeoplewithtype2diabeteswilleventuall
7、yneedtreatmentwithoralhypoglycaemicagents.Metforminreducesglycatedhaemoglobinby1?2%,reducesmortalitycomparedwithdietalone,anddoesnotaffectweight,butcancausehypoglycaemia.SulphonylureasreduceHbA1ccomparedwithdieta