Paquot Nicolas, Scheen André J
Université de Liège, Service de diabétologie, nutrition et maladies métaboliques, CHU Liège, Belgique.
Unité de pharmacologie clinique, CHU Sart Tilman, 4000 Liège, Belgique.
Rev Med Suisse. 2017 Aug 23;13(571):1410-1415.
After failure of a monotherapy with metformin, dipeptidyl peptidase-4 inhibitors (gliptins) and sodium-glucose cotransporters type 2 (gliflozins) offer an alternative to the add-on of a sulphonylurea, especially in diabetic patients at risk of hypoglycaemia. The choice between a gliptin and a gliflozin may be guided by the individual patient characteristics : rather a gliptin in a patient without obesity or severe hyperglycaemia, in an elderly patient, with a frailty profile or with renal impairment; rather a gliflozin in an obese patient, with hypertension, hyperuricaemia, antecedents of cardiovascular disease (especially heart failure), without advanced renal insufficiency and with a low risk of urinary/genital infections or events linked to dehydration such as hypotension.
在二甲双胍单药治疗失败后，二肽基肽酶-4抑制剂（格列汀类）和钠-葡萄糖协同转运蛋白2抑制剂（列净类）可作为添加磺脲类药物的替代选择，尤其适用于有低血糖风险的糖尿病患者。选择格列汀类还是列净类可根据患者个体特征来决定：对于无肥胖或严重高血糖的患者、老年患者、身体虚弱或有肾功能损害的患者，更倾向于选择格列汀类；对于肥胖患者、有高血压、高尿酸血症、心血管疾病史（尤其是心力衰竭）、无晚期肾功能不全且泌尿/生殖系统感染或与脱水相关事件（如低血压）风险较低的患者，更倾向于选择列净类。
