Mateos L, Herraez García J, Martin Oterino J A, Sánchez Rodríguez A
Servicio de Medicina Interna I, Hospital Universitario de Salamanca, Salamanca, España.
Rev Clin Esp. 2010 Jan;210(1):23-7. doi: 10.1016/j.rce.2009.04.003. Epub 2010 Jan 9.
A 62-year old woman with obesity, high blood pressure and type 2 diabetes mellitus (DM2) was referred to a Vascular Risk Unit of the Internal Medicine Department due to elevated HbA1C (8.1%) in spite of having taken metformin (850 mg/12h) and glipizide (10 mg/12 h) regularly. She tries to exercise daily (walking 30 min) and has lost weight (from 5 to 12 kg) several times, but always regains what she has lost. Furthermore, she monitors her glucose levels in fasting every two weeks and generally has between 120 and 160 mg/dL. Her high blood pressure is being treated with enalapril/HCTZ and she also takes aspirin 100mg/day and simvastatin 20 mg/day. It is seen in her family background that one brother died suddenly at 50 years of age. Her physical examination shows a BMI of 32.4 Kg/m(2), and she has no edemas in the lower limbs. Her BP is 154/82 mmHg and creatinine 0.9 mg/dL. She has no microalbuminuria and her liver function is normal. What treatment do you think would be the more appropriate? 1 - Add glitazones. 2 - Add incretin mimetics (GLP 1/ DPP-4). 3 - Slow acting insulin.
一名62岁女性，患有肥胖症、高血压和2型糖尿病（DM2），尽管规律服用二甲双胍（850毫克/12小时）和格列吡嗪（10毫克/12小时），糖化血红蛋白（HbA1C）仍升高（8.1%），遂被转诊至内科血管风险科。她每天尝试锻炼（步行30分钟），并多次减重（从5千克减至12千克），但体重总是反弹。此外，她每两周监测一次空腹血糖水平，血糖一般在120至160毫克/分升之间。她的高血压正在用依那普利/氢氯噻嗪治疗，她还每天服用100毫克阿司匹林和20毫克辛伐他汀。在她的家族背景中，有一个哥哥在50岁时突然去世。体格检查显示她的体重指数（BMI）为32.4千克/平方米，下肢无水肿。她的血压为154/82毫米汞柱，肌酐为0.9毫克/分升。她没有微量白蛋白尿，肝功能正常。你认为哪种治疗更合适？1 - 添加格列酮类药物。2 - 添加肠促胰岛素类似物（GLP-1/DPP-4）。3 - 长效胰岛素。
