Moses R
Diabetes Metab. 1999 Dec;25 Suppl 7:26-7.
In addition to dietary and lifestyle changes, standing as the cornerstone of type 2 diabetes care, pharmacological treatments, whether as single or multidrug patterns, are often necessary for an efficient blood glucose control. Besides insulin, four different oral antidiabetic drug categories are available, each of them acting through different and potentially synergistic ways. Oral antidiabetic drugs include: 1) biguanides acting through the reduction of hepatic glucose production and are most efficient in obese patients; 2) alpha-glucosidase inhibitors delaying carbohydrate intestinal absorption; 3) thiazolidinediones or "glitazones", acting as insulin sensitizers; 4) insulin secretion enhancers, mainly including sulfonylureas, which increase insulin secretion and are being credited by a long clinical usage; these are now joined by the new generation of insulin secretion enhancers, led by repaglinide, which can mimic the physiological insulin secretion profile by a specific stimulatory effect on beta-cells characterized by its fast onset and short half-life. Obviously, the combination of these different antidiabetic drugs, by targetting different synergistic and additive pathways, can help to further improve blood glucose.
除了饮食和生活方式的改变（这是2型糖尿病治疗的基石）之外，药物治疗，无论是单药治疗还是联合用药模式，对于有效控制血糖通常都是必要的。除胰岛素外，有四种不同类型的口服抗糖尿病药物，它们各自通过不同且可能具有协同作用的方式发挥作用。口服抗糖尿病药物包括：1）双胍类药物，通过减少肝脏葡萄糖生成发挥作用，对肥胖患者最为有效；2）α-葡萄糖苷酶抑制剂，延迟碳水化合物在肠道的吸收；3）噻唑烷二酮类药物或“格列酮类”药物，作为胰岛素增敏剂；4）胰岛素分泌促进剂，主要包括磺脲类药物，这类药物可增加胰岛素分泌且长期临床应用已得到认可；现在新一代胰岛素分泌促进剂加入其中，以瑞格列奈为首，它可通过对β细胞的特异性刺激作用模拟生理性胰岛素分泌模式，其特点是起效快、半衰期短。显然，这些不同的抗糖尿病药物联合使用，通过针对不同的协同和相加途径，有助于进一步改善血糖。
