Ascaso Juan F
Hospital Clínico Universitario de Valencia-INCLIVA, Departamento de Medicina, Universitat de València, Valencia, España; Centro de Investigación Biológica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Instituto de Salud Carlos III, Valencia, España.
Med Clin (Barc). 2014 Aug 4;143(3):117-23. doi: 10.1016/j.medcli.2013.05.041. Epub 2013 Aug 9.
The benefits and problems associated with traditional hypoglycemic drugs, such as failure of beta cells, hypoglycemia and weight gain, that lead to a worsening of diabetes, are reviewed. New hypoglycemic drugs with incretin effect (glucagon-like peptide-1 agonists and dipeptidyl peptidase 4 inhibitors), achieve, in a glucose dependent manner, an glycosylated hemoglobin reduction without hypoglycemia or increase in body weight. Recently, another group of oral hypoglycemic drugs, sodium-glucose cotransporter type 2 inhibitors, have demonstrated efficacy in diabetes control by inhibiting renal glucose reabsorption. However, long-term effects and cardiovascular prevention remain to be demonstrated. We have more and better drugs nowadays. Hypoglycemic treatment should be customized (glycosylated hemoglobin levels, risk-benefit, risk of hypoglycemia, weight changes, cardiovascular risk), with a combination of drugs being necessary in most cases. However, we do not have yet an ideal hypoglycemic drug. Moreover we must remember that an early and intensive treatment of dyslipidemia and hypertension is essential for the prevention of cardiovascular disease in patients with type 2 diabetes.
本文回顾了传统降糖药物的益处与问题，如β细胞功能衰竭、低血糖及体重增加等，这些问题会导致糖尿病病情恶化。具有肠促胰岛素效应的新型降糖药物（胰高血糖素样肽-1激动剂和二肽基肽酶4抑制剂）以葡萄糖依赖的方式降低糖化血红蛋白水平，且不会引发低血糖或导致体重增加。近来，另一类口服降糖药物——钠-葡萄糖协同转运蛋白2抑制剂，通过抑制肾脏对葡萄糖的重吸收，在控制糖尿病方面显示出疗效。然而，其长期效果及心血管保护作用仍有待证实。如今我们有了更多更好的药物。降糖治疗应个体化（依据糖化血红蛋白水平、风险效益、低血糖风险、体重变化、心血管风险），多数情况下需要联合用药。然而，我们尚未拥有理想的降糖药物。此外，必须牢记，早期强化治疗血脂异常和高血压对于预防2型糖尿病患者的心血管疾病至关重要。
