Miravet I Jiménez Sònia
Medicina de Familia, EAP Martorell Rural i Urbà, Martorell, Barcelona, España.
Semergen. 2018 Jun;44 Suppl 1:3-9. doi: 10.1016/S1138-3593(18)30369-1.
The development of new drugs to treat hyperglycemia in persons with type 2 diabetes mellitus and recent cardiovascular safety studies of these new molecules have created the need to update the various clinical practice guidelines and consensus documents on the approach and treatment of this highly prevalent disease. Metformin continues to be the first-line drug. Dipeptidyl peptidase-4 inhibitors are oral lipid-lowering drugs with specific characteristics favouring their use in primary care. Among other characteristics, these drugs have few drug-drug interactions, can be easily combined with other drugs, are well tolerated, have a neutral effect on weight, and have a low risk of producing hypoglycaemic episodes, all of which encourages their prescrip-tion. Dipeptidyl peptidase-4 inhibitors are considered as second-line drugs (and as first-line drugs if metformin is contraindicated or poorly tolerated). In some specific situa-tions, this position could be threatened by the development of new drug families, such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 analogues, which have shown benefits in reducing major cardiovascular events and mortality. It is important to determine the current place of dipeptidyl peptidase-4 inhibitors in the treatment of type 2 diabetes mellitus, since they have been increasingly prescribed in primary care in the last few years.
用于治疗2型糖尿病患者高血糖的新药研发以及这些新分子最近的心血管安全性研究，使得有必要更新关于这种高度流行疾病的治疗方法和治疗的各种临床实践指南及共识文件。二甲双胍仍然是一线药物。二肽基肽酶-4抑制剂是具有特定特性的口服降脂药物，有利于在基层医疗中使用。这些药物的其他特性包括药物相互作用少、可轻松与其他药物联合使用、耐受性良好、对体重有中性影响以及发生低血糖事件的风险低，所有这些都促使它们被处方使用。二肽基肽酶-4抑制剂被视为二线药物（如果二甲双胍禁忌或耐受性差，则作为一线药物）。在某些特定情况下，这一地位可能会受到新药物家族（如钠-葡萄糖协同转运蛋白-2抑制剂和胰高血糖素样肽-1类似物）发展的威胁，这些新药物家族已显示出在降低主要心血管事件和死亡率方面的益处。确定二肽基肽酶-4抑制剂在2型糖尿病治疗中的当前地位很重要，因为在过去几年中它们在基层医疗中的处方越来越多。
