Meneghini Luigi, Hirsch Irl B
University of Miami Miller School of Medicine, Diabetes Research Institute, Miami, Florida 33136, USA.
Semin Thorac Cardiovasc Surg. 2006 Winter;18(4):379-89. doi: 10.1053/j.semtcvs.2007.01.003.
Over the past several years, the pharmacologic options for the management of glycemic control have tremendously expanded. Whereas prior to the introduction of metformin therapy in 1995 the only alternatives were human insulin therapies and sulfonylurea drugs, we now have the option of using several different classes of oral antidiabetic drugs, injectable non-insulin therapies, and insulin analogs. In this article we present a functional classification of glycemic therapies available for the treatment of diabetes in an attempt to provide the clinician with a practical framework which optimize blood glucose management. Patients with diabetes, especially type 2 diabetes, are often managed with a wide variety of injectable and non-injectable options in the attempt to improve glycemic control and glycemic variability, minimize hypoglycemia (as well as weight gain) and prevent both micro- and macrovascular complications. We specifically focus on novel therapies and present macrovascular complications. We specifically focus on novel therapies and present information about their efficacy and safety, as well as potential contraindications. The last section of this paper will present some suggestions for how to manage glycemia in the in-patient setting, including the use of rapid and long-acting insulin preparations to cover fasting and nutritional needs, as well as the proper use of insulin scales.
在过去几年中，用于血糖控制管理的药物选择大幅增加。在1995年二甲双胍疗法引入之前，唯一的选择是人类胰岛素疗法和磺脲类药物，而现在我们可以选择使用几种不同类型的口服抗糖尿病药物、注射用非胰岛素疗法和胰岛素类似物。在本文中，我们对可用于治疗糖尿病的血糖疗法进行了功能分类，旨在为临床医生提供一个优化血糖管理的实用框架。糖尿病患者，尤其是2型糖尿病患者，通常会使用多种注射和非注射方法进行治疗，以改善血糖控制和血糖变异性，将低血糖（以及体重增加）降至最低，并预防微血管和大血管并发症。我们特别关注新型疗法，并介绍大血管并发症。我们特别关注新型疗法，并介绍其疗效、安全性以及潜在的禁忌症。本文的最后一部分将针对住院患者血糖管理提出一些建议，包括使用速效和长效胰岛素制剂来满足空腹和营养需求，以及正确使用胰岛素剂量换算表。
