Grunberger George
Grunberger Diabetes Institute, 43494 Woodward Avenue, suite 208, Bloomfield Hills, MI, 48302, USA.
Internal Medicine and Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, USA.
Curr Diab Rep. 2017 Apr;17(4):21. doi: 10.1007/s11892-017-0853-8.
There are currently over 40 different drugs in 12 distinct classes approved in the USA to treat patients with type 2 diabetes mellitus. This review summarizes our current knowledge about potential side effects of antidiabetic therapy and attempts to apply it to a clinical practice setting.
Given the heterogeneity of both the patients and the disease, it is mathematically impossible to test every available drug combination in long-term outcome, prospective, randomized blinded fashion before a clinician decides which agent(s) to prescribe to a specific patient in a given situation. To complicate the clinician's dilemma, there is lack of available tests to predict an individual's response or propensity to side effects. Further, the data available are derived from small, short-term registration trials and typically focus on relative rather than absolute risks of any given drug and do not address the potential adverse outcomes if a patient's diabetes remains untreated. Clinicians have to personalize their choice of antidiabetic therapy based both on the specific characteristics of the patient in front of them (stage of diabetes and its complications, overall health status, socioeconomic situation, other medications present, desire to improve control of diabetes, etc.) and the current knowledge about the relative and absolute balance of benefits and risks of any individual medication in that specific patient. It has to be recognized that this requires constant re-evaluation as database of our experience with antidiabetic therapy expands.
目前在美国有12个不同类别、超过40种不同药物被批准用于治疗2型糖尿病患者。本综述总结了我们目前对抗糖尿病治疗潜在副作用的认识，并尝试将其应用于临床实践。
鉴于患者和疾病的异质性，在临床医生决定在特定情况下给特定患者开哪种药物之前，要以长期结果、前瞻性、随机双盲的方式对每一种可用的药物组合进行测试，在数学上是不可能的。使临床医生的困境更加复杂的是，缺乏可用的测试来预测个体对副作用的反应或倾向。此外，现有的数据来自小型、短期的注册试验，通常关注任何给定药物的相对风险而非绝对风险，并且没有涉及如果患者的糖尿病仍未得到治疗可能出现的不良后果。临床医生必须根据眼前患者的具体特征（糖尿病阶段及其并发症、整体健康状况、社会经济状况、正在服用的其他药物、改善糖尿病控制的愿望等）以及关于该特定患者中任何一种药物的相对和绝对的利弊平衡的现有知识，来个性化选择抗糖尿病治疗方案。必须认识到，随着我们抗糖尿病治疗经验数据库的扩大，这需要不断重新评估。
