Choby Beth
University of Tennessee Health Science Center Department of Medical Education, 920 Madison Building 7th floor, Memphis, TN 3816-30000.
FP Essent. 2017 May;456:27-35.
Multiple new drugs for managing type 2 diabetes have entered the market in the past 5 years. Guidelines from the American Diabetes Association recommend metformin for initial therapy, followed by a second drug if A1c goals are not met or initially for patients with A1c levels greater than 9%. Conversely, the American Association of Clinical Endocrinologists recommends initial management with two drugs if the A1c level is greater than 7.5%. The risk of lactic acidosis associated with metformin has been shown to be less than previously thought, with newer guidelines permitting use with an estimated glomerular filtration rate of 45 to 60 mL/min/1.73 m. Newer studies provide a better understanding of the mechanisms of and indications for use of sodium-dependent glucose cotransporter 2 inhibitors, glucagon-like peptide 1 receptor agonists, and inhaled insulin.
在过去5年里，多种用于治疗2型糖尿病的新药已进入市场。美国糖尿病协会的指南推荐二甲双胍作为初始治疗药物，如果糖化血红蛋白（A1c）目标未达成，或者对于A1c水平高于9%的患者，则在初始治疗时就使用第二种药物。相反，美国临床内分泌医师协会建议，如果A1c水平高于7.5%，则初始治疗使用两种药物。与二甲双胍相关的乳酸性酸中毒风险已被证明低于此前的认知，新指南允许在估算肾小球滤过率为45至60 mL/min/1.73 m²时使用。新的研究使人们对钠-葡萄糖协同转运蛋白2抑制剂、胰高血糖素样肽1受体激动剂和吸入性胰岛素的作用机制及使用指征有了更好的理解。
