Dailey George
Scripps Clinic, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA.
Curr Diab Rep. 2005 Oct;5(5):329-32. doi: 10.1007/s11892-005-0089-x.
Sulfonylurea compounds were the first available oral antidiabetic agents and they remain an important tool in our quest for optimal glycemic control. The more recent introduction of meglitinides offers an approach to short-term insulin release with minimal hypoglycemic risk during fasting periods. Published trials suggest that individuals with a hemoglobin A(1c) above 8.5% are unlikely to reach currently recommended targets (6.5% to 7%) without the use of one of these insulin secretagogues. Starting and probable maximally effective doses for glimepiride are 1 to 2 mg initially and 4 mg thereafter. For glyburide and glipizide, these are 2.5 to 5 mg initially, and 10 mg effective at a maximum. The large majority of the effect can be seen within a week, making them very attractive when rapid lowering of glucose is needed. An understanding of the principles will facilitate more effective use of initial and combination therapy.
磺脲类化合物是最早可用的口服抗糖尿病药物，并且在我们寻求最佳血糖控制的过程中，它们仍然是一项重要工具。较新引入的格列奈类药物提供了一种在空腹期间实现短期胰岛素释放且低血糖风险最小的方法。已发表的试验表明，血红蛋白A1c高于8.5%的个体如果不使用这些胰岛素促泌剂之一，不太可能达到目前推荐的目标（6.5%至7%）。格列美脲的起始剂量和可能的最大有效剂量最初为1至2毫克，此后为4毫克。对于格列本脲和格列吡嗪，最初剂量为2.5至5毫克，最大有效剂量为10毫克。绝大多数效果可在一周内显现，当需要快速降低血糖时，这使它们非常具有吸引力。了解这些原则将有助于更有效地使用初始治疗和联合治疗。
