盐酸二甲双胍与阿卡波糖治疗2型糖尿病的药物经济学评价

复习评价盐酸二甲双胍和阿卡波糖治疗2型糖尿病的临床疗效与药物经济学的相关文献,应用药物经济学方法对该两种口服降糖药物治疗2型糖尿病进行综合评价,主要从安全性、有效性、经济性方面进行分析,虽然盐酸二甲双胍和阿卡波糖不但具有较好的临床疗效而且具有良好的药物经济学,但是因为2型糖尿病的临床疗效评价指标较为复杂,很难应用单一指标来反映治疗的产出,故在评价治疗效果时应该采用综合评价指标,以期为临床实践中合理治疗糖尿病提供有益的建议和指导。     

我院2005-2009年口服降糖药物使用情况分析

目的了解医院口服降糖药物的使用情况、应用特点及趋势,为临床合理应用提供参考。方法对该院2005-2009年口服降糖药物的种类、用量、销售金额、用药频度等进行统计分析。结果降糖药物销售金额逐年上升,其中α-糖苷酶抑制剂占了将近一半。5年间全部降糖药中销售金额稳居前两位的是伏格列波糖和阿卡波糖,而DDDs稳居前2位的则是阿卡波糖和二甲双胍。结论该院降糖药物的使用基本合理。     

我院2005-2009年口服降糖药物使用情况分析

目的 了解医院口服降糖药物的使用情况、应用特点及趋势,为临床合理应用提供参考.方法 对该院2005-2009年口服降糖药物的种类、用量、销售金额、用药频度等进行统计分析.结果 降糖药物销售金额逐年上升,其中α-糖苷酶抑制剂占了将近一半.5年间全部降糖药中销售金额稳居前两位的是伏格列波糖和阿卡波糖,而DDDs稳居前2位的则是阿卡波糖和二甲双胍.结论 该院降糖药物的使用基本合理.     

我院2008年至2010年口服降糖药应用情况分析

目的 调查我院糖尿病患者口服降糖药应用情况,分析口服降糖药物应用合理性.方法 采用用药频度(DDDs)和药物利用指数( DUI)法,对我院各类口服降糖药销售金额统计进行分析.结果 我院2008至2010年口服降糖药的销售金额排名前3位的是阿卡波糖、二甲双胍、瑞格列奈,DDDs以二甲双胍,阿卡波糖为高.结论 我院降糖药应用情况基本合理.     

我院2008年~2011年门诊口服降糖药用药分析

目的:调查分析我院2008～20011年门诊口服降血糖药物的使用情况及趋势,为临床合理使用降血糖药物提供参考。方法:调取我院微机管理系统提供的2008年～20011年门诊口服降血糖药物的应用数据,分析比较各药物的使用情况。结果:我院门诊口服降血糖药物的数量及销售金额呈增长趋势,DDDs排序前3位是阿卡波糖、二甲双胍及格列喹酮。药品销售金额首位为阿卡波糖,另外那格列奈销售金额逐年上升,稳居第2位。结论:2008年～2011年我院门诊患者口服降血糖药的数量和销售金额呈上升趋势,价廉且疗效确切的降糖药在临床应用中占优势,品种选择中体现了有效性和安全性的特点,使用情况基本合理。     

我院2007-2009年口服降糖药应用分析

目的：了解我院口服降糖药使用现状及发展趋势,促进临床合理用药。方法：对我院2007-2009年口服降糖药的销售金额、用药频度（DDDs）、日均费用（DDC）等进行回顾性分析。结果：我院2007-2009年口服降糖药销售金额呈上升趋势,销售金额排在前三位的是阿卡波糖、盐酸二甲双胍片、格列美脲;DDDs排序前三位的是阿卡波糖、盐酸二甲双胍片、格列喹酮。结论：我院口服降糖药应用基本合理,新药用量呈上升趋势,高效、安全、依从性好的药物临床应用广泛。     

我院门诊口服降糖药物用药分析

目的分析我院门诊口服降糖药物的使用情况,为临床合理使用该类药物提供参考。方法对我院2008～2010年度门诊西药房的各类口服降糖药物的种类、用量、金额、用药频度和日均费用等数据进行统计分析。结果本院2008～2010年销售金额最高的两类口服降糖药物是α-糖苷酶抑制剂和磺酰脲类促胰岛素分泌剂;用药频度排序占据前三位的药物分别是阿卡波糖(拜糖平)、格列喹酮(糖适平)和二甲双胍(格华止);那格列奈(唐力)和瑞格列奈(诺和龙)的日均费用最高;而销售金额和用药人次同步性最好的是阿卡波糖(拜糖平)。结论我院门诊口服降糖药物的种类组成和临床使用情况基本合理。     

我院2000～2002年口服降血糖药物应用分析

目的为临床合理应用口服降血糖药提供信息.方法应用金额和用药频度排序法,对我院2000～2002年口服降血糖药物的使用金额、主要品种及其DDDs值进行统计分析.结果格列吡嗪、格列齐特为我院主要降血糖药物,阿卡波糖用药呈上升趋势.结论我院近3年口服降血糖药物应用基本稳定.     

阿卡波糖片治疗2型糖尿病的应用研究进展

阿卡波糖片是一种α-糖苷酶抑制剂,该药物对2型糖尿病的治疗效果理想。为总结阿卡波糖片的临床疗效,本研究通过查阅国内外文献,分析药物治疗的优点,旨在对2型糖尿病的防治提供有利参考。     

栝楼提取物的α-葡萄糖苷酶抑制活性研究

目的初步考察栝楼提取物对α-葡萄糖苷酶活性的影响。方法以阿卡波糖为阳性对照,测定栝楼提取物的酶抑制率。结果栝楼提取物对α-葡萄糖苷酶活性有不同程度的抑制作用,其中栝楼乙酸乙酯提取物对α-葡萄糖苷酶的抑制作用略强于阿卡波糖,IC50为0.336g·L-1。结论栝楼提取物在体外对α-葡萄糖苷酶均具有一定的抑制作用,有望开发成一种新的降糖药物。     

二甲双胍联合阿卡波糖治疗2型糖尿病的效果观察

目的观察二甲双胍联合阿卡波糖治疗2型糖尿病的临床效果。方法选取本院2011年3月~2012年7月收治的70例2型糖尿病患者,随机分为两组,各35例,对照组采用二甲双胍治疗,观察组采用二甲双胍联合阿卡波糖治疗,治疗2个月,比较两组的FPG、2hPG和HbA1c。结果两组治疗后的FPG、2hPG和HbA1c均下降,观察组下降更明显,差异有统计学意义（P〈0.05）。结论二甲双胍联合阿卡波糖治疗2型糖尿病的疗效肯定,安全性高,值得推广应用。     

甘精胰岛素联合格列美脲和阿卡波糖治疗磺脲类药物治疗失效的2型糖尿病的疗效观察

目的探讨甘精胰岛素注射液联合格列美脲片和阿卡波糖片治疗磺脲类药物治疗失效的2型糖尿病的临床疗效。方法选取2014年10月—2016年6月中山大学附属第三医院粤东医院内分泌科收治的磺脲类药物治疗失效的2型糖尿病患者136例,按照治疗方案的不同分为甘精胰岛素联合格列美脲组(44例)、甘精胰岛素联合阿卡波糖组(43例)、甘精胰岛素联合格列美脲和阿卡波糖组(49例)。甘精胰岛素联合格列美脲组每日晚餐后皮下注射甘精胰岛素注射液,起始剂量10 U/d;晚餐后30 min口服格列美脲片2 mg。甘精胰岛素联合阿卡波糖组每日晚餐后皮下注射甘精胰岛素注射液,起始剂量10 U/d;口服阿卡波糖片50 mg,3次/d;甘精胰岛素联合格列美脲和阿卡波糖组每日晚餐后皮下注射甘精胰岛素,起始剂量10 U/d;晚餐后30 min口服格列美脲片2 mg;口服阿卡波糖片50 mg,3次/d。治疗3个月后比较各观察指标。结果治疗后,3组空腹血糖(FBG)、餐后2 h血糖(2hPG)、糖化血红蛋白(HbA1c)水平均降低(P0.05),且甘精胰岛素联合格列美脲和阿卡波糖组血糖指标改善优于甘精胰岛素联合格列美脲组、甘精胰岛素联合阿卡波糖组(P0.05)。治疗后,3组稳态模型评估胰岛素抵抗指数(HOMA-IR)降低,胰岛β细胞功能指数(HOMA-β)、餐后2 h胰岛素、餐后2 h C-肽均升高(P0.05),且甘精胰岛素联合格列美脲和阿卡波糖组胰岛功能改善优于甘精胰岛素联合格列美脲组、甘精胰岛素联合阿卡波糖组(P0.05)。甘精胰岛素联合格列美脲和阿卡波糖组血糖达标时间短于甘精胰岛素联合格列美脲组、甘精胰岛素联合阿卡波糖组(P0.05),胰岛素日用量低于甘精胰岛素联合格列美脲组、甘精胰岛素联合阿卡波糖组(P0.05),低血糖发生率低于甘精胰岛素联合格列美脲组(P0.05),而与甘精胰岛素联合阿卡波糖组差异无统计学意义。结论甘精胰岛素注射液联合格列美脲片和阿卡波糖片治疗磺脲类药物治疗失效的2型糖尿病可有效控制血糖水平,缩短血糖达标时间,且不增加低血糖发生率,具有一定的临床推广应用价值。     

Evaluation of the potential clinical and economic effects of bodyweight stabilisation with acarbose in patients with type 2 diabetes mellitus. A decision-analytical approach

Bodyweight is an acknowledged independent risk factor for coronary heart disease (CHD). The present model analysis was undertaken to investigate the clinical and economic impact of bodyweight gain in patients with type 2 (non-insulin-dependent) diabetes mellitus and its effects on the development of CHD. Based on a retrospective re-evaluation of data from the Diabetes Intervention Study (DIS), patients with type 2 diabetes mellitus and stable bodyweight (group A) had a significantly lower rate of combined CHD events (30.3%) than patients showing a bodyweight gain (group B; 38.2%) over 10 years. Prevention of bodyweight gain, therefore, appears to be a meaningful strategy in the management of diabetes mellitus. In addition to this clinical advantage, prevention of CHD will also result in economic savings associated with avoided treatment of coronary events. Based on the clinical outcomes from the DIS, the calculated per-patient net savings for a patient with type 2 diabetes mellitus and stable bodyweight amounted to 1085 deutschmarks (DM) when compared with a patient experiencing a bodyweight increase. In a further step, the above situation was projected to current type 2 diabetes mellitus practice. Oral first-line treatment of type 2 diabetes mellitus is usually initiated with glibenclamide (glyburide), which is known to increase bodyweight (reflecting group B). The novel alpha-glucosidase inhibitor acarbose, in contrast, appears to be as effective as glibenclamide, but has the advantage of being bodyweight-neutral (reflecting group A). From the clinical viewpoint, acarbose can thus be considered an alternative to glibenclamide. From the viewpoint of drug costs, monotherapy with acarbose is 4 times as expensive as glibenclamide in Germany, resulting in per-patient incremental costs of DM3527 for acarbose over 10 years. Balanced against the potential 10-year cost saving of DM1085 resulting from the potential of acarbose to prevent CHD, around one-third of the incremental cost of acarbose may be recouped by this single effect. However, further possible benefits of acarbose, including the avoidance of hypoglycaemia and the deferral of costly insulin therapy, may improve the economic value of this novel antidiabetic agent. Given the indirect approach of this evaluation and its many limitations, the above findings need critical appraisal, and comparative trials are urgently required to substantiate our preliminary results.     

我院2006—2008年口服降糖药利用分析

目的了解医院口服降糖药的使用情况,判断应用是否合理,为临床用药提供参考。方法通过药物利用分析方法对医院2006—2008年口服降糖药的用药频率及销售金额等进行统计、分析。结果销售金额排在前3位的分别是阿卡波糖、格列齐特、二甲双胍,用药频度（DDDs）排前3位的分别是阿卡波糖、二甲双胍、格列齐特。结论口服降糖药的使用基本合理。磺酰脲类与α-葡萄糖苷酶抑制剂占主导地位,胰岛素敏感改善剂吡格列酮等新药临床反映良好,预计用药量会有所增加。     

2008年我院门诊口服降糖药应用分析

目的：评价本院门诊口服降糖药使用情况,为临床合理用药提供参考。方法：对本院门诊2008年1～12月口服降糖药应用品种、销售金额、用药频度（DDDs）进行统计、分析。结果：用药频度最高的是快速促胰岛素分泌剂、双胍类、磺酰脲类、α-糖苷酶抑制剂,单品种用药频度排序前四位的是瑞格列奈、格列齐特缓释片、二甲双胍、阿卡波糖,药物利用指数（DUI）大部分小于1。结论：DDDs排序反映了本院门诊口服降糖药用药的趋势,本院降糖药应用基本合理。     

The effect of miglitol and acarbose after an oral glucose load: a novel hypoglycaemic mechanism?

1. Alpha-glucosidase inhibitors such as miglitol and acarbose lower blood glucose after a starch load in healthy volunteers and diabetic patients by interfering with the conversion of disaccharide to monosaccharide in the gastrointestinal tract. 2. The effect of placebo, 100 mg miglitol and 100 mg acarbose given 30 min prior to a 75 g oral glucose load was investigated in nine healthy Caucasian volunteers. 3. Miglitol produced a statistically significant fall in post-peak blood glucose levels when compared with placebo and acarbose. Serum insulin did not change significantly. 4. As miglitol is well absorbed and acarbose is not, it is suggested that miglitol has a systemic hypoglycaemic effect, probably related to its close structural similarity to glucose, which warrants further investigation.     

Acarbose. A preliminary review of its pharmacodynamic and pharmacokinetic properties, and therapeutic potential

Acarbose delays the production of monosaccharides (notably glucose) by inhibiting the alpha-glucosidases associated with the brush-border membrane of the small intestine which are responsible for the digestion of complex polysaccharides and sucrose. In healthy subjects acarbose 100 to 200 mg significantly inhibits postprandial glucose, insulin and triglyceride responses, with some evidence of carbohydrate malabsorption with the higher dose. Clinical trials in patients with non-insulin-dependent diabetes mellitus showed that acarbose improved diabetic control, especially postprandial blood glucose levels, independent of whether the patients were receiving concomitant oral antidiabetic drugs in addition to dietary management. In comparative studies acarbose was significantly superior to placebo, and comparable to biguanides, when used alone or as an adjuvant to sulphonylurea therapy. Trials in patients requiring insulin to control their diabetes demonstrated that acarbose significantly reduced postprandial blood glucose concentrations, resulting in a smoother diurnal blood glucose-time curve and improved symptoms associated with nocturnal hypoglycaemia. Daily insulin requirements were sometimes reduced. In large multicentre trials acarbose up to 600 mg/day for 3 to 12 months improved glycaemic control in approximately 55% of patients with non-insulin-dependent or insulin-dependent diabetes mellitus. Apart from its use in diabetes, encouraging preliminary results have been obtained with acarbose in other therapeutic areas such as dumping syndrome, reactive hypoglycaemia, and types IIb and IV hyperlipoproteinaemias--however, further clinical experience is needed in these settings before clear conclusions can be drawn. No serious side effects have been reported during treatment with acarbose, although it is associated with a high incidence of troublesome gastrointestinal symptoms such as flatulence, abdominal distension, borborygmus and diarrhoea. The incidence of these reactions usually decreases with time. Thus, acarbose represents the first of a new class of oral antidiabetic drugs--the alpha-glucosidase inhibitors. It has proven useful for improving glycaemic control when used as an adjunct to standard therapy involving dietary restriction, oral antidiabetic drugs and/or subcutaneous insulin. That being the case, acarbose should provide the clinician with an interesting treatment option which can be used in a broad range of patients with diabetes mellitus in whom 'traditional' management approaches produce suboptimal glycaemic control.     

α-糖苷酶抑制剂阿卡波糖的临床药理作用

阿卡波糖的降血糖作用 ,已经得到认可。长期服用阿卡波糖在血糖尤其是餐后血糖得到有效控制后 ,还观察到对糖尿病病人的血脂代谢 ,血压的控制以及胃肠道功能的改善等方面具有明显的作用。此外 ,其继发的饱食作用可以明显改善病人的饥饿感     

Acarbose, an alpha-glucosidase inhibitor, improves insulin resistance in fructose-fed rats

Insulin resistance is one of the determinants of postprandial hyperglycemia. Acarbose is an alpha-glucosidase inhibitor that delays the absorption of carbohydrates from the small intestine, thereby suppressing postprandial hyperglycemia. Recently, acarbose has been found to reduce the incidence of cardiovascular disease (CVD) in patients with diabetes. These observations suggest that intervention of postprandial hyperglycemia with acarbose is a promising strategy for the prevention of CVD in diabetic patients. However, the effects of acarbose on insulin sensitivity are not fully understood. In this study, we examined whether oral administration of acarbose could improve insulin sensitivity in fructose-fed rats, a widely used insulin-resistant animal model. Although plasma glucose levels remained unchanged during the experiments, serum insulin levels were significantly increased in fructose-fed rats, which were suppressed by 4 weeks of treatment with acarbose. Acarbose treatment also increased high-density lipoprotein levels in fructose-fed rats. Furthermore, treatment of acarbose inhibited the elevation of systolic blood pressure levels in fructose-fed rats. These results indicate that oral administration of acarbose improves insulin sensitivity in fructose-fed rats. Our present study suggests that the cardioprotecive effects of acarbose could be ascribed, at least in part, to its insulin-sensitizing property.