2型糖尿病患者口服降糖药物预后及影响因素分析

目的:研究2型糖尿病患者口服降糖药物治疗模式及血糖控制水平的影响因素.方法:选取我院2015年7月~2017年4月收治的100例2型糖尿病患者,采用调查问卷进行问卷调查,对其口服降糖药物的治疗模式以及血糖控制水平影响因素进行研究分析.结果:患者口服降糖药物的主要类型为糖苷酶抑制剂、格列奈类、噻唑烷二酮类、磺脲类与双胍类;应用频率最高的治疗方式为两种药物联用,最常用的给药方案为双胍类与磺脲类药物联用;HbAlc达标率为50%;血糖未达标和未达标组的吸烟、文化程度、健康教育、运动、饮食控制情况、医保情况、病程与体质量指数差异存在统计学意义.结论:两种药物联用为主要治疗方式,影响血糖达标的因素包括文化程度低、健康教育、运动控制、饮食控制以及BMI升高等.     

社区医院门诊2型糖尿病患者口服降糖药物应用调查及分析

目的：调查并分析我院门诊2型糖尿病患者口服降糖药物应用情况。方法：随机抽查我院2013年1～12月门诊的256张2型糖尿病患者的处方,调查分析患者的年龄、性别;降糖药的类型、使用剂量、规格及联合用药等情况。结果：应用口服降糖药的男女比为1.05∶1,患者年龄以＞60岁为主,占49.6%;口服降糖药使用频率最高的为二甲双胍,频率为57.03%。仅应用1种降糖药为64例,占25.00%,两种降糖药合用135例,占52.73%,3种降糖药合用57例,占22.27%。结论：我社区医院口服降糖药使用基本合理,但仍需加强用药监测,制定实施个体化给药方案,促进药物合理使用。     

门诊老年2型糖尿病患者降糖药物应用分析

目的了解门诊老年2型糖尿病患者降糖药物的用药特点及规律,初步评估降糖药物使用的合理性,为促进降糖药物的临床合理使用提供参考。方法借助医院HIS系统,回顾性分析2019年在医院内分泌门诊就诊的老年2型糖尿病患者的降糖方案。结果共纳入2 058例患者,男∶女=1 055∶1 003,年龄为68.61±7.15岁。单药口服是最常见的降糖给药方式。胰岛素类药物的用药频率最高,其次为二甲双胍、阿卡波糖和二肽基肽酶-4(DPP-4)抑制剂。单药和两药联合降糖是主要的治疗方案。最常用的单药降糖治疗方案是用胰岛素,餐时胰岛素+基础胰岛素是最常用的两药联合降糖治疗方案。阿卡波糖+二甲双胍+胰岛素是常用的三药联合治疗方案。结论二甲双胍使用率偏低,未体现出指南推荐的一线用药地位。部分联合用药会导致低血糖风险高,应密切关注。该院门诊老年2型糖尿病患者降糖药的使用基本合理。     

2型糖尿病口服降糖药物的评价

口服降糖药已问世50多年，近年新型口服降糖药物的研发为临床医生提供了更多的治疗选择，同时又增加了医生在选择药物时要做更多的思考。临床医生该如何正确认识和使用这些药物呢？解放军总医院内分泌科主任陆菊明教授对此做出了评价。     

门诊口服降糖药物应用调查分析

目的:调查门诊糖尿病患者口服降糖药物的应用情况,分析其联合用药情况和处方习惯.方法:回顾性调查浙江大学医学院附属第一医院门诊糖尿病患者口服降糖药物使用情况.结果:1 081张糖尿病患者门诊处方中,口服降糖药物的使用率达84.09%,其中单用占40.33%,两联用药占29.05%,三联用药占7.86%,联用胰岛素占6.85%,单用胰岛素的占15.91%;常用的口服降糖药物有促胰岛素分泌剂(磺脲类和格列奈类)、双胍类、α-糖苷酶抑制剂和胰岛素增敏剂(噻唑烷二酮类).结论:依据各类口服降糖药物的作用机制和不同特点,该院口服降糖药物的应用是较合理的.     

我院门诊口服降糖药物的利用调查分析

本文通过查阅我院门诊处方 96 72张 ,对其中所使用的口服降糖药进行药物利用度调查。报告如下。1　方法2 0 0 1年 1月～ 12月门诊所有使用口服降糖药物的处方均在调查统计之列 ,调查内容为各种降糖药的名称、用法、规格及联合用药情况等。2　结果2 .1　处方情况　本次调查处方 96 72张 ,口服降糖药处方2 95张 ,占调查总处方的 3.0 5 % ,降糖药物在处方中出现总频数为 332次。2 .2　各口服降糖药物处方频数及所占比例见表 1。表 1　口服降糖药物在处方中出现频数及百分比类别药品名称出现频数百分比 ( % )排序第二代磺酰脲类格列喹酮 (糖适平…     

清远市清新区2型糖尿病患者降糖药物的用药分析

目的：调查分析广东省清远市清新区2型糖尿病患者的降糖药物使用情况,为临床合理用药提供参考。方法：选择广东省清远市清新区2380例2型糖尿病患者作为研究对象,发放调查问卷进行调查,并对降糖药物使用情况进行总结分析。结果：药物使用中使用比例较高的为双胍类,使用率为89.97%,其次为磺脲类和α-糖苷酶抑制剂,使用率分别为71.97%和55.97%。药物使用频率较高的则是盐酸二甲双胍与阿卡波糖,使用频率分别为79.03%和57.02%。双胍类+磺脲类降糖药物组合使用率为71.47%,是既往使用药物类别组合中比例最大的,其次为双胍类+磺脲类+α-糖苷酶抑制剂药物组合,占50.63%。空腹血糖（FBG）和2hPBG水平较低的患者的病程相对较短、服用降糖药物品种较少,FBG和2hPBG水平较高的患者,病程相对较长、服用降糖药物品种较多。病程较短的患者合并症与服用降糖药物品种相对较少,病程较长的患者的合并症与服用降糖药物品种相对较多。结论：广东省清远市清新区2型糖尿病患者降糖药物的用药较为科学合理,符合临床治疗规范,部分通过降糖药物控制血糖不理想的患者,可应用胰岛素进行治疗。     

卫生院2型糖尿病住院患者降糖药物使用情况调查分析

目的 了解该卫生院2型糖尿病住院患者降糖药物使用情况,为基层医疗卫生机构规范使用降糖药物提供参考。方法 从寿光市圣城街道卫生院的医院信息系统中选取2019年1—12月765例2型糖尿病住院患者的临床资料,分析降糖药物使用情况。结果 使用频次前三位的降糖药物分别是胰岛素（74.1%,567/765）、双胍类（63.9%,489/765）、磺脲类（27.6%,211/765）;使用单药治疗的患者常用降糖药物居前两位的是胰岛素（74.6%,144/193）、双胍类14.0%(27/193),二联治疗居前两位的是双胍类+胰岛素（47.6%,156/328）、双胍类+磺脲类（20.4%,67/328）;应用降糖药物品种共计32种,使用前三位的分别是二甲双胍（63.9%,489/765）、格列美脲（25.9%,198/765）、诺和灵30R(25.2%,193/765);口服降糖药物+注射降糖药联合治疗者占比最高（55.6%,425/765）。结论 该卫生院2型糖尿病住院患者降糖药物治疗方案基本合理,符合《中国2型糖尿病防治指南（2020年版）》《国家基层糖尿病防治管理指南（2018）》推荐的路径...     

中效胰岛素联合口服降糖药物治疗2型糖尿病38例临床分析

对于部分长期服二甲双胍的2型糖尿病患者,无论如何调整服药剂量,血糖控制都不能达到较满意的结果。而近年来的临床研究及观察表明,2型糖尿病的胰岛素强化治疗优势日趋显著,它能有效控制血糖,且可以减少慢性并发症的发生与发展[1]。本文旨在观察对于口服二甲双胍血糖控制不佳的2     

门诊2型糖尿病患者口服降糖药降糖达标状况调查

目的了解门诊仅接受口服降糖药物治疗的2型糖尿病(T2DM)患者降糖达标现状及糖尿病慢性并发症、合并症的发生情况。方法收集我院门诊仅接受口服降糖药物治疗(3个月以上)的T2DM病例401例,通过问卷调查的方式收集患者血糖、HbA1c值、血压、血脂、自我管理信息、治疗方案、合并症及慢性并发症等情况,评估HbA1c≤6.5%的达标现状及糖尿病慢性并发症、合并症的发生情况。结果血糖控制现状调查显示HbA1c≤6.5%的达标率为17.5%;HbA1c>6.5%组合并心脑血管疾病、慢性并发症的比率明显高于HbA1c≤6.5%组;36.9%患者血糖监测频率≥4次每月,13.7%患者HbA1c监测频率≥4次每年;患者控制饮食、规律运动的比例分别为74.6%、51.6%;大多数患者应用2种及以上降糖药物治疗。结论门诊仅接受口服药物治疗的T2DM患者血糖控制达标率低,血糖控制不良与糖尿病合并症、慢性并发症相关。     

Comparative safety of newer oral antidiabetic drugs

Oral antidiabetic agents were introduced into clinical practice during the 1950s. Biguanides and sulfonylureas are still used extensively today and their safety and tolerability profiles are well defined. Developments and refinements within these classes have included the introduction of second- and third-generation sulfonylureas, the introduction of modified-release preparations, and the emergence of fixed-dose preparations with metformin and with novel drugs. The latter include the thiazolidinediones, agents with a putative genomic mechanism of action that have been under intense scrutiny since the emergence of severe hepatotoxicity with troglitazone. Recent concerns about thiazolidinediones have centred on the issue of oedema and the risk of precipitating heart failure in vulnerable patients. Only prolonged exposure will determine the long-term safety of thiazolidinediones. Rapid-acting non-sulfonylurea secretagogues appear to be effective and perhaps safer than sulfonylureas in some groups of patients with certain comorbidities (e.g., those with renal impairment). α-Glucosidase inhibitors have an excellent safety record and acarbose has been shown to retard the progression from impaired glucose tolerance to Type 2 diabetes. However, their use is limited by tolerability issues.     

SGLT2 inhibition: efficacy and safety in type 2 diabetes treatment

Introduction: Inhibitors of sodium-glucose cotransporters type 2 (SGLT2) offer a new opportunity for the management of type 2 diabetes mellitus. These agents reduce hyperglycemia by decreasing the renal glucose threshold and thereby increasing urinary glucose excretion. Subsequent reduction of glucotoxicity improves beta-cell sensitivity to glucose and tissue insulin sensitivity.

Areas covered: This article analyzes the efficacy and safety data of canagliflozin, dapagliflozin and empagliflozin in randomized controlled trials of 24 – 104 weeks duration, compared with placebo or an active comparator, in patients treated with diet/exercise, metformin, dual oral therapy or insulin.

Expert opinion: SGLT2 inhibitors significantly and consistently reduce glycated hemoglobin, with a minimal risk of hypoglycemia. The improvement of glucose control is similar or slightly better compared with metformin, sulfonylureas or sitagliptin, with the add-on value of significant reductions in body weight and blood pressure. However, caution is recommended in fragile elderly patients and patients with chronic kidney disease. An increased risk of genital mycotic infections is observed, but urinary tract infections are rare. Concern about an unexpected risk of euglycemic ketoacidosis has been recently reported. A possible renal protection deserves further attention. A remarkable reduction in cardiovascular mortality was reported in EMPA-REG OUTCOME with empagliflozin.     

口服降糖药联合甘精胰岛素治疗2型糖尿病的疗效观察

目的 观察在口服降糖药的基础上联合甘精胰岛素治疗2型糖尿病（T2DM）的临床效果。方法对49例单用降糖药效果欠佳的T2DM患者联用甘精胰岛素治疗,分别于治疗前及治疗后（3个月）观察空腹血糖（FPG）、餐后2h血糖（2hPG）、血脂、血压、体重指数的变化。结果联用甘精胰岛素治疗后FPG、2hPG、HbA1c较治疗前明显下降（P〈0．01）,而血脂、血压、体重指数影响不大,且无明显低血糖反应。结论口服降糖药联合甘精胰岛素治疗方案具有作用佳、安全性好的特点。     

口服降糖药对2型糖尿病患者心血管安全性的应用评价

目的: 探讨目前临床常用口服降糖药对2型糖尿病患者心血管安全性的影响。方法: 以"口服降糖药"2型糖尿病"心血管安全性"等为关键词,组合检索2000-2015年PubMed、中国知网、万方等数据库中口服降糖药的心血管安全性的相关研究文献,对其中涉及的心血管安全性方面的评价进行综述。结果: 共检索到相关文献68篇,其中有效文献41篇。通过总结发现心血管事件是导致糖尿病患者死亡的主要原因,大量的研究表明不同口服降糖药物对心血管安全性的影响存在明显差异,而且相关的循证医学的研究还在进行。结论: 为了不断提高糖尿病患者用药的安全性,我们有必要密切关注口服降糖药对心血管事件的影响。     

Glycemic control and the first use of oral antidiabetic agents among patients with type 2 diabetes mellitus

Abstract

Objective:

Examine how patients diagnosed with type 2 diabetes mellitus (T2DM) are treated with oral antidiabetic (OAD) agents and the relationship between treatment patterns and glycemic control.     

Vildagliptin in the treatment of type 2 diabetes mellitus

Introduction: Inhibition of dipeptidyl peptidase IV (DPP-4) augments glucose-dependent insulin release and is a new approach to the treatment of type 2 diabetes (T2DM). Vildagliptin is a new DPP-4 inhibitor approved in many countries for the treatment of T2DM. This review provides an overview of vildagliptin with emphasis on its pharmacology and clinical effectiveness.

Areas covered: Results of preclinical and several Phase II and III studies from 2004 – 2010 are discussed.

Expert opinion: Vildagliptin acts to inhibit the breakdown of glucagon-like peptide (GLP)-1, which in turn enhances the beta-cell response to glucose and inhibits glucagon secretion. It is an effective agent alone or in combination in patients with T2DM, resulting in modest improvements in HbA1c usually in the 0.5 – 1% range. Advantages include weight neutrality and a lesser incidence of hypoglycemia. Concerns remain regarding its use in renal disease and potential complications seen in animal models.     

Pharmacokinetic and pharmacodynamic evaluation of linagliptin in African American patients with type 2 diabetes mellitus

Aim

This was an open label, multicentre phase I trial to study the pharmacokinetics and pharmacodynamics of the dipeptidyl peptidase-4 (DPP-4) inhibitor linagliptin in African American patients with type 2 diabetes mellitus (T2DM).

Methods

Forty-one African American patients with T2DM were included in this study. Patients were admitted to a study clinic and administered 5 mg linagliptin once daily for 7 days, followed by 7 days of outpatient evaluation.

Results

Primary endpoints were area under the plasma concentration–time curve (AUC), maximum plasma concentration (C_max) and plasma DPP-4 trough inhibition at steady-state. Linagliptin geometric mean AUC was 194 nmol l⁻¹ h (geometric coefficient of variation, 26%), with a C_max of 16.4 nmol l⁻¹ (41%). Urinary excretion was low (0.5% and 4.4% of the dose excreted over 24 h, days 1 and 7). The geometric mean DPP-4 inhibition at steady-state was 84.2% at trough and 91.9% at maximum. The exposure range and overall pharmacokinetic/pharmacodynamic profile of linagliptin in this study of African Americans with T2DM was comparable with that in other populations. Laboratory data, vital signs and physical examinations did not show any relevant findings. No safety concerns were identified.

Conclusions

The results of this study in African American patients with T2DM support the use of the standard 5 mg dose recommended in all populations.     

我院门诊药房2009—2012年口服降糖药使用情况分析

目的：了解我院门诊药房口服降糖药物的临床应用情况。方法：采用金额排序和限定日剂量（DDD）分析法,统计2009-2012年我院门诊药房降糖药物的消耗情况、用药费用、日用药金额（DDC）、品种分布、以及化学类与中成药降糖药的构成比。结果：我院口服降糖药销售金额呈逐年上升趋势,阿卡波糖、瑞格列奈和二甲双胍位于各年度销售金额前3位。二甲双胍在各年度用药频度（DDDs）中均居前3位。2009-2012年格列美脲DDDs呈逐年上升趋势。在6类化学降糖药中,α-葡萄糖苷酶抑制剂销售金额的构成比居首位。阿卡波糖的DDC居首位。噻唑烷二酮胰岛素增敏剂类降糖药销售金额构成比呈逐年降低趋势。我院口服降糖中成药销售金额的构成比呈逐年上升趋势。结论：我院口服降糖药的应用基本合理。     

Dapagliflozin: potential beneficial effects in the prevention and treatment of renal and cardiovascular complications in patients with type 2 diabetes

Introduction: Diabetic kidney disease is the leading cause of end-stage renal disease, a significant contributor to cardiovascular (CV) disease, responsible for much of the morbidity and mortality in patients with type 2 diabetes (T2DM). Strategies to slow or prevent the onset and progression of diabetic kidney disease are critical for effectively managing T2DM and reducing CV risk. Sodium-glucose cotransporter 2 (SGLT2) inhibitors are effective antidiabetic agents, which may provide nephroprotective and CV protective effects.

Areas covered: This review examines the role of the kidney in glucose homeostasis, discusses renal hemodynamic changes in diabetes, and outlines the major hypotheses regarding the mechanisms underlying renal injury in diabetes. The potential benefits of SGLT2 inhibitors in the prevention and treatment of CV complications in patients with T2DM are reviewed, with particular focus on dapagliflozin.

Expert opinion: Dapagliflozin and other SGLT2 inhibitors have the capacity to decrease hyperglycemia and visceral fat, components of the metabolic syndrome particularly associated with the progression of CV disease. However, the mechanisms of action of SGLT2 inhibitors resulting in their positive CV effects remain unclear. Furthermore, the mechanism of action of SGLT2 inhibitors on heart function in non-diabetic patients with decompensated heart failure remains to be explored.     

肠道益生菌对2型糖尿病合并代谢综合征患者的临床疗效观察

目的：观察常规治疗联合培菲康对2型糖尿病合并代谢综合征患者血糖、血脂、血压、体重控制的临床疗效。方法：收集2015年4月1日—2015年6月30日期间在甘泉街道社区卫生服务中心门诊就诊的2型糖尿病合并代谢综合征患者100例,采用1：1配对分组（年龄、性别、基础疾病）法分为对照组和试验组各50例,对照组给予常规降糖、降脂、降压治疗,试验组加用培菲康840 mg,2次/d口服,疗程为6周。比较治疗前后两组血糖、血脂、血压、体重变化以及停药后6周的疗效差异。结果：6周后试验组与对照组相比血糖、血压、血脂、体质均未见明显差异（P>0.05）;然而停药6周后,两组空腹血糖、餐后2 h血糖、总胆固醇数值下降具有统计学意义（P<0.05）。结论：调节肠道菌群,能够改善代谢综合征患者血糖、血脂指标,远期疗效值得期待。