Type 2 diabetes mellitus: What is the optimal treatment regimen?
Type 2 diabetes mellitus: What is the optimal treatment regimen?
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DOI：
10.1016/j.amjmed.2003.10.017
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发表时间：
2004-03-08
影响因子：
5.9
通讯作者：
Bell, DSH
中科院分区：
文献类型：
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作者：
Bell, DSH
2型糖尿病的治疗选择目前包括胰岛素。致敏剂、α-葡糖苷酶抑制剂、促分泌剂和胰岛素。然而，初始治疗的重点已经从促分泌素和α-葡萄糖苷酶抑制剂转移到胰岛素增敏剂，如二甲双胍和噻唑烷二酮类（TZD）。本文概述了作为2型糖尿病综合治疗方案的一部分，维斯α-葡萄糖苷酶抑制剂和促分泌素相比，增敏剂治疗的益处。促分泌素和α-葡糖苷酶抑制剂仅有效降低血糖水平，而胰岛素增敏剂除了降低血糖水平之外还降低几种重要的心脏风险因素。TZD尤其有益于其保持甚至恢复胰腺β细胞功能的能力。治疗方案采用分层方法，从胰岛素增敏剂治疗的组合开始，逐步进展为三联口服治疗，并添加促分泌素，如有必要，添加皮下胰岛素以维持血糖控制。
Treatment options for type 2 diabetes mellitus currently consist of insulin. sensitizers, alpha-glucosidase inhibitors, secretagogues, and insulin. However, the emphasis on initial therapy has been shifting from secretagogues and alpha-glucosidase inhibitors to insulin sensitizers such as metformin and the thiazolidinediones (TZDs). This article outlines the benefits of treatment with sensitizers vis a vis alpha-glucosidase inhibitors and secretagogues as part of a comprehensive treatment algorithm for type 2 diabetes. Secretagogues and a-glucosidase inhibitors effectively lower plasma glucose levels only, whereas insulin sensitizers reduce several important cardiac risk factors in addition to reducing plasma glucose levels. TZDs, in particular, are also beneficial for their ability to preserve or even rejuvenate pancreatic beta-cell function. The treatment algorithm has a layered approach, beginning with a combination of insulin-sensitizer therapy and incrementally progressing to triple oral therapy with the addition of secretagogues and, if necessary, the addition of subcutaneous insulin to maintain glycemic control.