BHF Cardiovascular Research Centre, University of Glasgow, Glasgow G12 8TA, UK.
QJM. 2011 Mar;104(3):185-92. doi: 10.1093/qjmed/hcq237. Epub 2010 Dec 13.
This review considers the therapeutic choices currently faced by people with type 2 diabetes and those caring for them when glucose levels initially controlled with lifestyle management and metformin start to rise. While sulphonylureas are familiar agents and cheaper than other alternatives, they cause hypoglycaemia and modest weight gain, and robust outcome data are still lacking. Dipeptidyl peptidase 4 inhibitors ('gliptins') have an attractive pharmacological and adverse effect profile, but their effects on the cardiovascular system are also uncertain. Thiazolidinediones ('glitazones') are effective glucose-lowering agents, but cause weight gain and increase the risk of fracture, while the cardiovascular benefits hoped for in association with 'insulin-sensitization' have not been as expected. Glucagon-like peptide-1 agonists will not be acceptable as initial second-line agents for many people as they are injectable rather than oral. Well-powered 'head-to-head' clinical trials of adequate duration are therefore required to allow evidence-based decisions on second-line therapy.
这篇综述考虑了 2 型糖尿病患者及其照护者在通过生活方式管理和二甲双胍初步控制血糖后，血糖开始上升时面临的治疗选择。磺酰脲类药物是常见的药物，而且比其他替代品便宜，但它们会导致低血糖和适度的体重增加，而且仍然缺乏强有力的结果数据。二肽基肽酶 4 抑制剂（“gliptins”）具有有吸引力的药理学和不良作用谱，但它们对心血管系统的影响也不确定。噻唑烷二酮类药物（“glitazones”）是有效的降糖药物，但会导致体重增加和骨折风险增加，而与“胰岛素增敏”相关的心血管益处并未如预期的那样。由于胰高血糖素样肽-1 激动剂是注射剂而不是口服剂，因此许多人不会接受其作为一线二线药物。因此，需要进行强有力的、具有足够时长的“头对头”临床试验，以便能够根据二线治疗的证据做出决策。
