Carrera Boada C A, Martínez-Moreno J M
Department of Endocrinology, Hospital de Clínicas, Av. Panteón, Urb. San Bernardino, Caracas, Venezuela.
Nutr Hosp. 2013 Mar;28 Suppl 2:3-13. doi: 10.3305/nh.2013.28.sup2.6707.
Current medical treatment of type 2 diabetes mellitus (T2DM) requires special attention to different comorbidities that often are associated with hyperglycemia, such as overweight or obesity, dyslipidemia, hypertension, microvascular or macrovascular complications, etc. .. The control of these factors risk to health is as important as the glucose control in diabetes type 2, it is essential for the antidiabetes drugs consider these risk factors. The consensus statement published by the ADA/EASD and AACE emphasizes that the potential effects of antidiabetes medications on CV risk factors besides hyperglycemia (ie, overweight/obesity, hypertension, and dyslipidemia) should be considered in pharmacotherapy selection. Since T2DM is a progressive disease with worsening HbA1C values over time, monotherapy, even with different agents, will eventually fail to maintain the glycemic target. Because insulin resistance occurs in a variety of organs and tissues, many patients may achieve fasting glycemic control but develop postprandial hyperglycemia. Other issues include the risk for hypoglycaemia or weight gain with traditional glucose-lowering medications. The AACE/ACE algorithm for glycemic control is structured according to categories of HbA1C and suggests an HbA1C goal of =6.5%, although that may not be appropriate for all patients.42 The algorithm recommends monotherapy, dual therapy, or triple therapy based on initial HbA1C level of 6.5% to 7.5%, 7.6% to 9%, and >9% and reserves initiation of insulin therapy until treatment with oral or other injectable agents has failed. GLP-1 receptor agonists and DPP-4 inhibitors are novel options to improve glycemic control and reduce the incidence of weight gain. Combination therapy with newer and traditional agents improves glycemic control with a low incidence of hypoglycemia.
2型糖尿病（T2DM）的当前医学治疗需要特别关注通常与高血糖相关的不同合并症，如超重或肥胖、血脂异常、高血压、微血管或大血管并发症等。控制这些对健康有风险的因素与2型糖尿病的血糖控制同样重要，抗糖尿病药物考虑这些风险因素至关重要。美国糖尿病协会（ADA）/欧洲糖尿病研究协会（EASD）和美国临床内分泌医师协会（AACE）发表的共识声明强调，在选择药物治疗时应考虑抗糖尿病药物对除高血糖之外的心血管危险因素（即超重/肥胖、高血压和血脂异常）的潜在影响。由于T2DM是一种随着时间推移糖化血红蛋白（HbA1C）值不断恶化的进行性疾病，单一疗法，即使使用不同药物，最终也将无法维持血糖目标。由于胰岛素抵抗发生在多种器官和组织中，许多患者可能实现空腹血糖控制，但会出现餐后高血糖。其他问题包括使用传统降糖药物时发生低血糖或体重增加的风险。AACE/ACE血糖控制算法根据HbA1C类别构建，建议HbA1C目标为≤6.5%，尽管这可能并不适用于所有患者。该算法根据初始HbA1C水平6.5%至7.5%、7.6%至9%和>9%推荐单一疗法、双重疗法或三联疗法，并保留胰岛素治疗的启动，直到口服或其他注射药物治疗失败。胰高血糖素样肽-1（GLP-1）受体激动剂和二肽基肽酶-4（DPP-4）抑制剂是改善血糖控制和降低体重增加发生率的新选择。新型药物与传统药物联合治疗可改善血糖控制，且低血糖发生率较低。
