King Khalid University Hospital, King Saud University, Riyadh, Saudi Arabia.
Int J Clin Pract. 2010 Jan;64(2):149-59. doi: 10.1111/j.1742-1241.2009.02235.x.
Increases in the prevalence of type 2 diabetes will likely be greater in the Middle East and other developing countries than in most other regions during the coming two decades, placing a heavy burden on regional healthcare resources.
Medline search, examination of data from major epidemiological studies in the Middle Eastern countries.
The aetiology and pathophysiology of diabetes appears comparable in Middle Eastern and other populations. Lifestyle intervention is key to the management of diabetes in all type 2 diabetes patients, who should be encouraged strongly to diet and exercise. The options for pharmacologic therapy in the management of diabetes have increased recently, particularly the number of potential antidiabetic combinations. Metformin appears to be used less frequently to initiate antidiabetic therapy in the Middle East than in other countries. Available clinical evidence, supported by current guidelines, strongly favours the initiation of antidiabetic therapy with metformin in Middle Eastern type 2 diabetes patients, where no contraindications exist. This is due to its equivalent or greater efficacy relative to other oral antidiabetic treatments, its proven tolerability and safety profiles, its weight neutrality, the lack of clinically significant hypoglycaemia, the demonstration of cardiovascular protection for metformin relative to diet in the UK Prospective Diabetes Study and in observational studies, and its low cost. Additional treatments should be added to metformin and lifestyle intervention as diabetes progresses, until patients are receiving an intensive insulin regimen with or without additional oral agents.
The current evidence base strongly favours the initiation of antidiabetic therapy with metformin, where no contraindications exist. However, metformin may be under-prescribed in the Middle East.
在未来二十年，2 型糖尿病的患病率在中东和其他发展中国家可能比其他大多数地区都要高，这将给地区医疗保健资源带来沉重负担。
使用 Medline 搜索，并检查来自中东国家主要流行病学研究的数据。
糖尿病的病因和病理生理学在中东和其他人群中似乎相似。生活方式干预是所有 2 型糖尿病患者管理糖尿病的关键，应强烈鼓励他们饮食和运动。最近，用于糖尿病管理的药物治疗选择有所增加，特别是潜在的抗糖尿病组合的数量增加了。与其他国家相比，在中东，二甲双胍似乎较少用于启动抗糖尿病治疗。现有的临床证据，加上当前的指南，强烈支持在没有禁忌症的情况下，在中东 2 型糖尿病患者中使用二甲双胍启动抗糖尿病治疗。这是因为它相对于其他口服抗糖尿病药物具有同等或更高的疗效、已被证实的耐受性和安全性、中性体重、缺乏临床显著的低血糖、UKPDS 和观察性研究中二甲双胍相对于饮食对心血管的保护作用，以及它的低成本。随着糖尿病的进展，应在二甲双胍和生活方式干预的基础上增加其他治疗方法，直到患者接受强化胰岛素治疗，或有或没有其他口服药物。
目前的证据强烈支持在没有禁忌症的情况下，使用二甲双胍启动抗糖尿病治疗。然而，二甲双胍在中东的使用可能不足。
