Campbell R Keith, Miller Sara
Washington State University College of Pharmacy, Pullman, Washington, USA
Diabetes Educ. 2009 Sep-Oct;35(5):731-4, 738-40, 742-4 passim. doi: 10.1177/0145721709342900.
More than 24 million adults and children in the United States are living with diabetes, and the vast majority of those individuals have type 2 diabetes. The clinical benefits of good glycemic control have been well established. Most patients eventually require the use of multiple hyperglycemic drugs in combination to approach or achieve the American Diabetes Association's recommended target A1C value of 7%. The role of incretin-based therapies for both glycemic control and beta-cell protection has become an area of intense interest and development. Although current practice guidelines do not include specific recommendations about when and how to incorporate incretin-based agents, a consensus statement published by the American Diabetes Association/European Association for the Study of Diabetes suggests the addition of a glucagon-like peptide-1 (GLP-1) agonist for patients not at goal A1C with metformin and lifestyle changes. The goal of this article is to review this class of agents, discuss their role in the treatment of type 2 diabetes, and address the practical aspects of integrating incretin-based agents into the management of patients with diabetes.
Currently, 3 incretin-based therapies are available and widely used in clinical practice. Several more agents are either under review by the Food and Drug Administration (FDA) or are in the very late stages of development. For diabetes educators trying to help their patients understand the differences among their antidiabetic medications, a comprehensive understanding of these agents and their role in therapy is imperative.
美国有超过2400万成年人和儿童患有糖尿病，其中绝大多数为2型糖尿病患者。良好的血糖控制所带来的临床益处已得到充分证实。大多数患者最终需要联合使用多种降糖药物，以接近或达到美国糖尿病协会推荐的糖化血红蛋白（A1C）目标值7%。基于肠促胰素的疗法在血糖控制和β细胞保护方面的作用已成为一个备受关注和深入研究的领域。尽管当前的临床实践指南未包含关于何时以及如何使用基于肠促胰素药物的具体建议，但美国糖尿病协会/欧洲糖尿病研究协会发布的一份共识声明建议，对于未达到A1C目标值的患者，在使用二甲双胍并改变生活方式的基础上，加用胰高血糖素样肽-1（GLP-1）激动剂。本文的目的是综述这类药物，讨论它们在2型糖尿病治疗中的作用，并阐述将基于肠促胰素的药物纳入糖尿病患者管理的实际问题。
目前，有3种基于肠促胰素的疗法在临床实践中广泛应用。还有几种药物正在接受美国食品药品监督管理局（FDA）的审查，或已处于研发的后期阶段。对于试图帮助患者了解其抗糖尿病药物差异的糖尿病教育工作者而言，全面了解这些药物及其在治疗中的作用至关重要。
