Ishibashi Shun
Division of Endocrinology and Metabolism, Department of Medicine, Jichi Medical University.
Nihon Rinsho. 2006 Nov;64(11):2089-94.
Accumulating evidence supports that management of blood glucose levels is critical for the prevention of diabetic vascular complications including macroangiopathy. Several therapeutic modalities are available in the management of blood glucose levels. In type 2 diabetes with obesity, achievement of body weight control with intensive caloric restriction is essential. Sulfonylurea remains the central drug in the management in insulin-independent patients without obesity. For patients with insulin resistance, biguanide or thiazolidinediones are the drugs of choice. For patients with postprandial hyperglycemia, a-glucosidase inhibitors and meglitinide analogs should be considered. Combination of some of these drugs has additive effect for patients with suboptimal blood glucose control with monotherapy. When the above therapies fail, we should not hesitate to start insulin.
越来越多的证据支持，血糖水平的管理对于预防包括大血管病变在内的糖尿病血管并发症至关重要。在血糖水平管理方面有多种治疗方式。在伴有肥胖的2型糖尿病中，通过严格限制热量摄入实现体重控制至关重要。磺脲类药物仍然是无肥胖的非胰岛素依赖型患者管理中的核心药物。对于胰岛素抵抗患者，双胍类或噻唑烷二酮类药物是首选。对于餐后血糖高的患者，应考虑使用α-葡萄糖苷酶抑制剂和格列奈类药物。对于单药治疗血糖控制欠佳的患者，联合使用其中一些药物具有相加作用。当上述治疗失败时，我们应毫不犹豫地开始使用胰岛素。
