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胰高血糖素样肽-1 受体激动剂在亚洲 2 型糖尿病中的作用。

The Role of Glucagon-Like Peptide-1 Receptor Agonists in Type 2 Diabetes in Asia.

机构信息

Department of Endocrinology, Chinese PLA General Hospital, Beijing, China.

出版信息

Adv Ther. 2019 Apr;36(4):798-805. doi: 10.1007/s12325-019-00914-9. Epub 2019 Mar 11.

Abstract

The improvement of glycemic control in patients with type 2 diabetes (T2D) is an urgent need in Asia. East Asian T2D patients have distinct characteristics, including relatively low body weight, early impairment of islet beta cell function with reduced insulin secretion and a marked increase in postprandial blood glucose levels. Control of postprandial hyperglycemia and beta cell preservation are key elements of the therapeutic strategy for these patients. Glucagon-like peptide-1 receptor agonists (GLP-1RAs) reduce HbA1c, fasting plasma glucose, and (in particular) postprandial glucose levels, and slow gastric emptying, while minimizing the risk of hypoglycemia and weight gain. Compared with long-acting GLP-1RAs, short-acting GLP-1RAs produce greater slowing of gastric emptying (which is a key factor driving the reduction of postprandial glycemia) and induce beta cell rest rather than promoting postprandial insulin secretion when used under physiological conditions. GLP-1RAs have greater efficacy in Asian than Caucasian patients. GLP-1RA add-on therapy provides clinically meaningful reductions in HbA1c and postprandial glucose in Asians with T2D inadequately controlled by oral antidiabetic drugs (OADs) or basal insulin ± OADs. Premixed insulin is often prescribed for T2D patients in China. A short-acting GLP-1RA plus basal insulin is an alternative to premixed insulin, resulting in better efficacy and a lower risk of hypoglycemia and weight gain. In conclusion, GLP-1RAs, especially short-acting GLP-1RAs, are a practical treatment option for East Asian patients with T2D inadequately controlled by OADs or basal insulin.Funding: Sanofi.

摘要

改善 2 型糖尿病(T2D)患者的血糖控制在亚洲是当务之急。东亚 T2D 患者具有独特的特征,包括相对较低的体重、胰岛β细胞功能早期受损、胰岛素分泌减少以及餐后血糖水平显著升高。控制餐后高血糖和保护β细胞是这些患者治疗策略的关键要素。胰高血糖素样肽-1 受体激动剂(GLP-1RAs)可降低 HbA1c、空腹血糖,特别是餐后血糖水平,延缓胃排空,同时最大限度地降低低血糖和体重增加的风险。与长效 GLP-1RAs 相比,短效 GLP-1RAs 在生理条件下产生更大的胃排空减缓(这是降低餐后血糖的关键因素),并在诱导β细胞休息而不是促进餐后胰岛素分泌。GLP-1RAs 在亚洲患者中的疗效优于白种人患者。GLP-1RA 附加疗法可使口服降糖药(OADs)或基础胰岛素±OADs 控制不佳的亚洲 T2D 患者的 HbA1c 和餐后血糖得到有临床意义的降低。预混胰岛素常用于中国的 T2D 患者。短效 GLP-1RA 加基础胰岛素是预混胰岛素的替代方案,可带来更好的疗效,降低低血糖和体重增加的风险。总之,GLP-1RAs,特别是短效 GLP-1RAs,是 OADs 或基础胰岛素控制不佳的东亚 T2D 患者的一种实用治疗选择。资助:赛诺菲。

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