Medical Director, Florida Hospital Diabetes Institute, Senior Investigator, Translational Research Institute for Metabolism and Diabetes, Adjunct Professor, Sanford-Burnham Medical Research Institute at Lake Nona, Orlando, FL.
Family Physician, Clinical Assistant Professor, Department of Community Health and Family Medicine, University of Florida, Gainesville, FL.
Am J Med. 2014 Nov;127(11):e15-e16. doi: 10.1016/j.amjmed.2014.10.007. Epub 2014 Oct 15.
Despite the availability of a number of therapeutic options, management of type 2 diabetes (T2DM) and hyperglycemia remains suboptimal. Evidence shows that physicians are not adequately individualizing incretin-based therapies as there is lack of clear understanding of the similarities and differences between various incretin-based therapies. Additionally, sodium-dependent glucose co-transporter 2 (SGLT2) inhibitors, a very recent addition to the therapeutic armamentarium, are not adequately utilized in managing patients with T2DM due to a lack of awareness or an increased concern regarding their safety, efficacy, and the mechanism of action. Insulin therapy is also not initiated or intensified appropriately due to a lack of clear understanding on when to add and how to intensify them and, more importantly, due to fear of increasing the risk of hypoglycemia in patients. To address these gaps, in the first section of this educational activity, the expert faculty will review the current understanding of the risks associated with hypoglycemia-one of the main factors that limit the successful use of insulin therapy-and when to initiate insulin therapy, as well as the available data on the risk of hypoglycemia with emerging agents. The expert faculty will also provide practical strategies on how to minimize the risk of hypoglycemia in patients. In the second section, the expert faculty will highlight the differences between the various incretin-based therapies in addition to providing strategies for physicians to individualize their choice of incretin-based therapy. The expert faculty will also review the mechanism of action, safety, efficacy, and the appropriate place for this class of therapies in the treatment continuum. In the third section, the expert faculty will discuss the mechanism of action, safety, and efficacy of the currently available SGLT2 inhibitors as well as the appropriate use of these newer agents in T2DM management. This CME Multimedia Activity is also available through the Website of The American Journal of Medicine (www.amjmed.com). Click on the CME Multimedia Activity button in the navigation bar for full access. Or access: www.elseviercme.com/537.
尽管有多种治疗选择，但 2 型糖尿病（T2DM）和高血糖的管理仍不尽如人意。有证据表明，医生并没有充分地将基于肠促胰岛素的疗法个体化，因为他们对各种基于肠促胰岛素的疗法之间的相似性和差异性缺乏清晰的认识。此外，由于对其安全性、疗效和作用机制缺乏认识或过于担忧，钠-葡萄糖共转运蛋白 2（SGLT2）抑制剂作为治疗手段中的最新补充，在治疗 T2DM 患者时并未得到充分利用。由于对何时添加以及如何强化胰岛素治疗缺乏明确的认识，胰岛素治疗也没有得到适当的起始或强化，更重要的是，由于担心增加患者低血糖的风险。为了解决这些差距，在本次教育活动的第一部分，专家将回顾与低血糖相关的风险的现有认识——这是限制胰岛素治疗成功应用的主要因素之一——以及何时开始胰岛素治疗，以及关于新兴药物发生低血糖风险的现有数据。专家还将提供关于如何降低患者低血糖风险的实用策略。在第二部分，专家将重点介绍各种肠促胰岛素疗法之间的差异，此外还将为医生提供个性化选择肠促胰岛素疗法的策略。专家还将回顾该类疗法的作用机制、安全性、疗效以及在治疗连续体中的适当位置。在第三部分，专家将讨论目前可用的 SGLT2 抑制剂的作用机制、安全性和疗效，以及这些新型药物在 T2DM 管理中的适当应用。本 CME 多媒体活动也可通过《美国医学杂志》网站（www.amjmed.com）获取。点击导航栏中的 CME 多媒体活动按钮即可获取完整内容。或访问：www.elseviercme.com/537。
