Crossover studies can help the individualisation of care in type 2 diabetes: the MASTERMIND approach
Crossover studies can help the individualisation of care in type 2 diabetes: the MASTERMIND approach
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交叉研究有助于 2 型糖尿病的个体化护理：MASTERMIND 方法
DOI：
10.1002/pdi.2015
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发表时间：
2016
影响因子：
0.6
通讯作者：
Angwin C
中科院分区：
文献类型：
--
作者：
Angwin C
2型糖尿病患者的个体化护理是美国糖尿病协会（ADA）/欧洲糖尿病研究协会（EASD）1和国家健康与护理卓越研究所（NICE）2治疗指南的中心主题。这种个性化包括为个体患者设定适当的HbA1c目标，并主要根据特定副作用和成本的风险来确定治疗选择。还可以通过确定对一种降糖治疗反应特别好和/或治疗特异性副作用风险改变的患者亚组来进行个体化治疗。由于这适用于患者的群体或阶层，而不是个人，因此被称为“分层”。糖尿病分层的一个明显例子是，HNF1A MODY患者对磺脲类药物的反应是2型糖尿病患者的4倍3。这意味着这些患者可以使用非常低的磺脲类药物剂量实现出色的血糖控制。2型糖尿病缺乏单基因疾病的同质性;因此，我们能否在该组中确定对一种类型的降糖治疗反应更好的患者亚组？从表面上看，这应该是可能的;降糖治疗作用于不同部位，具有不同的作用机制，并且即使患者具有相似程度的高血糖症，患者也具有不同的病理生理学。虽然理论上很有吸引力，但迄今为止，特定亚组具有差异反应的证据有限。这主要反映了在确定对药物反应良好或不良的亚组方面所做的工作很少，更不用说试图确定特定治疗优于另一种治疗的亚组。
Individualising care for patients with Type 2 diabetes is a central theme in both the American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 1 and National Institute for Health and Care Excellence (NICE) 2 treatment guidelines. This individualisation involves setting an appropriate target HbA1c for an individual patient and determining choice of treatment primarily by risk of specific side effects and cost. Treatment could also be individualised by identifying subgroups of patients who respond particularly well to one type of glucose lowering therapy and/or have altered risk of treatment specific side effects. As this applies to groups or strata of patients rather than an individual it has been termed “stratification”. A clear example of stratification in diabetes is that patients with HNF1A MODY have a 4-fold better response to sulphonylureas than matched subjects with type 2 diabetes3. This means excellent glycaemic control can be achieved in these patients using very low sulphonylurea doses.Type 2 diabetes lacks the homogeneity of a single gene disease; can we therefore identify subgroups of patients within this group who will respond better to one type of glucose lowering therapy? On the face of it this should be possible; glucose lowering therapies act at different sites and have different mechanisms of action, and patients have differing pathophysiology even when they have a similar degree of hyperglycaemia. Although theoretically attractive, to date the evidence for specific subgroups having a differential response has been limited. This mainly reflects very little work being done to identify subgroups who respond well or badly to a medication and even less trying to identify subgroups where a specific treatment is favoured over another.
姑息治疗中单个患者（n-of-1）试验的优先药物
影响因子：
4.4
作者：
J. Nikles;Geoffrey Mitchell;Julie Walters;Janet Hardy;Phillip Good;Debra Rowett;Tania Shelby;David C. Currow
通讯作者：
David C. Currow
b 细胞衰竭标志物预示 2 型糖尿病患者对 GLP-1 受体激动剂治疗的血糖反应不佳
DOI：
--
发表时间：
2015
期刊：
影响因子：
--
作者：
A. Jones;T. Mcdonald;B. Shields;A. Hill;C. Hyde;B. Knight;A. Hattersley
通讯作者：
A. Hattersley