Yasuda Tetsuyuki, Shimomura Iichiro
Department of Metabolic Medicine, Osaka University Graduate School of Medicine.
Nihon Rinsho. 2013 Mar;71(3):555-62.
Type 2 diabetes mellitus is characterized by insulin resistance in peripheral tissues and relative impairment in insulin secretion from pancreatic beta cell. Insulin sensitizers such as metformin and pioglitazone reduce peripheral insulin resistance, whereas dipeptidyl peptidase-4(DPP-4) inhibitors augment postprandial insulin secretion and inhibit glucagon secretion. Combination therapy with an insulin sensitizer and a DPP-4 inhibitor provides substantial and additive glycemic improvement because of the complementary mechanisms of action of these agents. In addition, combination therapy with these agents is an attractive from the perspective of low incidence of hypoglycemia, beta cell preservation, augmentation of the incretin effect, and anti-atherogenic action.
2型糖尿病的特征是外周组织胰岛素抵抗以及胰腺β细胞胰岛素分泌相对受损。二甲双胍和吡格列酮等胰岛素增敏剂可降低外周胰岛素抵抗，而二肽基肽酶-4（DPP-4）抑制剂可增加餐后胰岛素分泌并抑制胰高血糖素分泌。胰岛素增敏剂与DPP-4抑制剂联合治疗可提供显著且累加的血糖改善，因为这些药物的作用机制具有互补性。此外，从低血糖发生率低、保护β细胞、增强肠促胰岛素效应以及抗动脉粥样硬化作用的角度来看，这些药物联合治疗颇具吸引力。
