Vergès B
Department of Endocrinology and Diabetes, University Hospital, Dijon, France.
Diabetes Nutr Metab. 2002 Dec;15(6 Suppl):28-32.
Post-prandial hyperglycaemia, which occurs early in the development of impaired glucose tolerance and Type 2 diabetes mellitus (T2DM), has been receiving increased attention recently. Post-prandial hyperglycaemia is likely to promote or aggravate fasting hyperglycaemia and contributes entirely to HbA1c elevation, which is associated with microvascular and macrovascular complications in people with T2DM. Moreover, post-prandial hyperglycaemia is coupled with coagulation activation and may be associated with an increased risk of cardiovascular disease in people with or without diabetes. For these reasons, reduction of post-prandial hyperglycaemia is an important target in patients with impaired glucose tolerance or T2DM. Several treatments have therefore been developed to reduce post-prandial hyperglycaemia; of these, repaglinide, a prandial glucose regulator taken orally before each meal, is now available. Drugs that reduce post-prandial hyperglycaemia significantly also decrease HbA1c (up to 2% with repaglinide) and fasting glucose concentrations (up to 3.9 mmol/l with repaglinide), with consequent decreases in coagulation activation and, in some studies, post-prandial lipidaemia. In clinical trials in patients with T2DM, repaglinide significantly reduced 2-hr post-prandial glucose concentrations and significantly reduced the risk of hypoglycaemia, compared with sulphonylureas, especially when participants missed or postponed a meal. Treatment with the prandial glucose regulator repaglinide allows patients with T2DM to have a more flexible lifestyle, which is likely to improve their quality of life and compliance.
餐后高血糖在糖耐量受损和2型糖尿病（T2DM）发展早期就会出现，近来受到越来越多的关注。餐后高血糖可能会促进或加重空腹高血糖，并且对糖化血红蛋白（HbA1c）升高有显著影响，而HbA1c升高与T2DM患者的微血管和大血管并发症相关。此外，餐后高血糖与凝血激活有关，可能与糖尿病患者或非糖尿病患者心血管疾病风险增加有关。基于这些原因，降低餐后高血糖是糖耐量受损或T2DM患者的一个重要治疗目标。因此，已经研发出几种降低餐后高血糖的治疗方法；其中，瑞格列奈，一种每餐饭前口服的餐时血糖调节剂，现已上市。能显著降低餐后高血糖的药物也会降低HbA1c（瑞格列奈可达2%）和空腹血糖浓度（瑞格列奈可达3.9 mmol/l），从而降低凝血激活，并且在一些研究中还能降低餐后血脂。在T2DM患者的临床试验中，与磺脲类药物相比，瑞格列奈能显著降低餐后2小时血糖浓度，并显著降低低血糖风险，尤其是当参与者错过或推迟进餐时。使用餐时血糖调节剂瑞格列奈进行治疗，能让T2DM患者拥有更灵活的生活方式，这可能会改善他们的生活质量和治疗依从性。
