Álvarez-Guisasola Fernando, Orozco-Beltrán Domingo, Cebrián-Cuenca Ana M, Ruiz Quintero Manuel Antonio, Angullo Martínez Escarlata, Ávila Lachica Luis, Ortega Millán Carlos, Caride Miana Elena, Navarro-Pérez Jorge, Sagredo Perez Julio, Barrot de la Puente Joan, Cos Claramunt Francesc Xavier
Medicina Familiar y Comunitaria, Centro de Salud Ribera del Órbigo, Benavides de Órbigo, León, España.
Medicina Familiar y Comunitaria, Unidad Investigación, Centro de Salud Cabo Huertas, Dpto. San Juan de Alicante, Alicante, España.
Aten Primaria. 2019 Aug-Sep;51(7):442-451. doi: 10.1016/j.aprim.2019.05.014. Epub 2019 Jul 15.
Treatment of diabetes mellitus type2 (DM2) includes healthy eating and exercise (150minutes/week) as basic pillars. For pharmacological treatment, metformin is the initial drug except contraindication or intolerance; in case of poor control, 8 therapeutic families are available (6 oral and 2 injectable) as possible combinations. An algorithm and some recommendations for the treatment of DM2 are presented. In secondary cardiovascular prevention, it is recommended to associate an inhibitor of the sodium-glucose cotransporter type 2 (iSGLT2) or a glucagon-like peptide-1 receptor agonist (arGLP1) in patients with obesity. In primary prevention if the patient is obese or overweight metformin should be combined with iSGLT2, arGLP1, or inhibitors of type4 dipeptidylpeptidase (iDPP4). If the patient does not present obesity, iDPP4, iSGLT2 or gliclazide, sulfonylurea, recommended due to its lower tendency to hypoglycaemia, may be used.
2型糖尿病（DM2）的治疗包括健康饮食和运动（每周150分钟）这两大基本支柱。在药物治疗方面，若无禁忌或不耐受情况，二甲双胍是初始用药；若控制不佳，有8类治疗药物（6种口服药和2种注射剂）可供选择并可进行联合使用。本文给出了DM2的治疗算法及一些建议。在二级心血管预防中，对于肥胖患者，建议联合使用钠-葡萄糖协同转运蛋白2抑制剂（iSGLT2）或胰高血糖素样肽-1受体激动剂（arGLP1）。在一级预防中，如果患者肥胖或超重，二甲双胍应与iSGLT2、arGLP1或4型二肽基肽酶抑制剂（iDPP4）联合使用。如果患者不肥胖，可以使用iDPP4、iSGLT2或格列齐特（一种磺脲类药物，因其低血糖倾向较低而被推荐）。
