Tan G H, Nelson R L
Division of Endocrinology/Metabolism, Mayo Clinic Rochester, MN 55905, USA.
Mayo Clin Proc. 1996 Aug;71(8):763-8. doi: 10.1016/S0025-6196(11)64841-6.
Non-insulin-dependent diabetes mellitus (NIDDM) is a major health concern for clinicians who are responsible for the care of an aging population. The relationship between hyperglycemia and the chronic complications of retinopathy, nephropathy, and neuropathy has been established in patients with insulin-dependent diabetes mellitus, and it is extremely likely that such a relationship exists in patients with NIDDM as well. Diet and exercise are the cornerstone for the management of NIDDM. The assessment of glycemic control should determine which patients with NIDDM need more aggressive intervention to control hyperglycemia. Pharmacologic treatment options include oral administration of the sulfonylureas, a biguanide, and an alpha-glucosidase inhibitor and subcutaneous administration of insulin. Extensive education about diabetes and self-monitoring of blood glucose levels are important components in maximizing glycemic control. Additional pharmacologic treatment options are necessary when adequate individualized treatment goals are not attained. The goal of therapy is to prevent the onset or progression of long-term microvascular and macrovascular complications. In this review, we present the therapeutic options and outline our approach to the pharmacologic treatment of NIDDM. Relevant medical literature on each treatment modality is reviewed, and the cost of therapy with use of each medication is provided.
非胰岛素依赖型糖尿病（NIDDM）是负责照料老年人群的临床医生所面临的主要健康问题。高血糖与胰岛素依赖型糖尿病患者视网膜病变、肾病和神经病变等慢性并发症之间的关系已经明确，NIDDM患者极有可能也存在这种关系。饮食和运动是NIDDM管理的基石。血糖控制评估应确定哪些NIDDM患者需要更积极的干预措施来控制高血糖。药物治疗选择包括口服磺脲类药物、双胍类药物和α-葡萄糖苷酶抑制剂以及皮下注射胰岛素。关于糖尿病的广泛教育和血糖水平的自我监测是实现最佳血糖控制的重要组成部分。当未达到充分的个体化治疗目标时，需要其他药物治疗选择。治疗的目标是预防长期微血管和大血管并发症的发生或进展。在本综述中，我们介绍了治疗选择，并概述了我们对NIDDM药物治疗的方法。对每种治疗方式的相关医学文献进行了综述，并提供了使用每种药物的治疗费用。
