口服降糖药物的合理应用

目前，糖尿病已经成为危害公众健康的主要疾病之一。糖尿病及其并发症不仅给社会医疗保健带来了沉重的负担，也严重影响糖尿病患者的生活质量。在2型糖尿病发生、发展的整个过程中，胰岛素抵抗贯穿始终，而胰岛素分泌则经历了一个由高到低的变化过程，因此，选择合理的治疗方案保护残存胰岛细胞功能，减少并发症的发生和发展至关重要。随着循证医学证据的不断出现，口服降糖药物在糖尿病治疗中的地位也随之变化，糖尿病治疗理念亦不断更新。在面对糖尿病患者个体时，一定要考虑到其所处的病程阶段，结合不同降糖药物的特性，合理选择，给予个体化治疗。     

口服降糖药物的学问

有不少糖尿病患者虽然服用降糖药物，但血糖控制并不理想，这是为什么呢？原来口服降糖药物还有许多讲究，糖尿病患者必须注意以下问题才能够有效地控制血糖。控制饮食是治疗糖尿病的基础对于初发的２型糖尿病患者，如果没有出现危及生命的并发症，首先应该控制饮食一个月左右。在控制饮食之后，血糖仍然不下降或下降不满意，又找不出其它特殊的原因，再考虑选用降糖药物治疗。有些患者不愿意控制饮食，想通过服用所谓特效药物或多服用一些降糖药物来抵消多吃的食物，这是非常错误的，很危险。因为高血糖反映了他们的胰岛素不足，或胰岛素不…     

口服降糖药物临床应用护理指导

目前，糖尿病（DM）已成为严重影响人类健康和生活质量的常见病之一，在其综合治疗措施（饮食、运动、药物、健康教育和自我控制）实施过程中，口服降糖药通常是最常用的控制血糖的方法。口服降糖药的服用方法相对简单，比较容易为DM患者接受，但要保证患者能够正确使用，血糖控制良好，仍需要护士对患者进行合理的护理和指导。为此，笔者对近年来对临床常用降糖药使用过程中所需要进行的护理与指导进行了总结。     

口服降糖药物的临床应用及进展

自20世纪50年代口服降糖药物问世以来，随着对糖尿病发病机制认识的不断深入，不仅新的口服降糖药物在不断地应用于临床，为糖尿病患者提供着越来越多的选择，同时，口服降糖药物应用的理念也在不断地更新。本文将对目前临床常用的口服降糖药物作以比较分析，并介绍口服降糖药物如何选择的最新进展。     

口服降糖药物应注意

糖尿病是常见的内分泌疾病,大多在40岁以后发病,常伴有高血压、肥胖。2型糖尿病大多数通过口服降血糖药物可控制,但在使用过程中应注意几点。 糖尿病病人应严格控制饮食,适当进行体育锻炼。只有在饮食、运动治疗不能取得满意效果时才使用药物治疗。如果病人对某一种     

降糖药物的合理使用

一、口服降糖药有哪些目前降糖药多系化学合成药,不下30余种,可分为两大类,即磺脲类与双胍类。磺屑类这类药物只可促进胰岛素释放,却不增加胰岛素的合成。因此对于有一定内生胰岛素分泌功能的病人才能奏效。 1、优降糖(格列本脲)为第二代磺脲类药物,降糖作用较强,使用时应从小剂量开始(2.5～5毫克)早餐后服用,最大量不超过15毫克/日,维持量为2.5～5毫克/日。 2、达美康(格列齐特)为第二代磺     

口服降糖药物的使用原则

糖尿病是严重危害人类健康的代谢性疾病,绝大多数糖尿病病人需口服降糖药物治疗。口服降糖药物种类很多,必须正确掌握其使用原则,才能达到治疗目的。 1．做好基础治疗,不能单纯依赖药物。无论哪类糖尿病,都必须坚持饮食治疗和运动治疗。必须在做好这些基     

老年人糖尿病口服降糖药物的治疗

糖尿病是一种常见多发的慢性代谢性疾病。随着社会的进步与发展，经济增长，生活水平提高，生活方式改变、人均寿命延长、肥胖、人口老龄化等均使糖尿病患人群持续增加。糖尿病已经成为继心脑血管疾病、恶性肿瘤之后严重危害人类健康的第三大疾患。     

门诊急诊口服降糖药物处方应用合理性分析

目的:探讨分析门诊急诊口服降糖药物处方应用合理性。方法:收集我院2016年6月-2016年9月含有口服降糖药的门急诊处方1894张,对处方单上使用的药物数量和品种的用药合理性进行统计分析。结果:双胍类口服降糖药物在处方中出现的次数有958次,出现频率为34%,是所有药物中出现次数最多的。磺酰脲类口服降糖药物出现的次数有842次,出现频率为36.8%。α-糖苷酶抑制剂口服降糖药物出现的次数有312次,频率为14.4%。噻唑烷二酮类口服降糖药物出现的次数有218次,频率为5.91%。格列奈类药物口服降糖药物出现的次数有156次,频率为8.9%。结论:在本研究中的门诊急诊口服降糖药物处方的应用较为合理,具有治疗II型糖尿病患者的治疗效果。     

Thiazolidinediones--a new class of oral antidiabetic drugs

The discovery of a new class of oral antidiabetic drugs was stimulated by difficulties with the treatment currently available for patients with type 2 diabetes mellitus. Thiazolidinediones can lower blood glucose values due to their special insulin-sensitiser effect. In this way, these drugs seem to be very effective in the treatment of type 2 diabetic patients with characteristics of metabolic syndrome. The intracellular action caused by thiazolidinediones differs markedly from that of other oral antidiabetic drugs available. Apart from antihyperglycaemic effect, thiazolidinediones have further beneficial effects in experimental diabetes which require corroboration by clinical studies. Troglitazone was the first drug which reached the market. Unfortunately, this drug was withdrawn soon due to its hepatotoxicity. Rosiglitazone proved to be much safer in clinical studies. Pioglitazone is being tested nowadays in clinical studies. Thiazolidinediones have been already listed among oral antidiabetic drugs in international therapeutical guidelines. Nevertheless, further clinical studies and experiences are needed to determine the final exact indication of thiazolidinediones for the treatment of type 2 diabetic patients.     

Dipeptidyl-peptidase-4 inhibitors (gliptins): a new class of oral antidiabetic drugs

Nearly 90% of the diabetic patients are suffering of type 2 diabetes while approximately 60-65% of patients with type 2 diabetes are treated with oral antidiabetic drugs. In the last couple of years a new treatment option, namely incretin-based therapy, became available. The dipeptidyl-peptidase-4-inhibitors (gliptins) are designated as incretin enhancers. Using gliptins, sustained glycemic control can be achieved without gaining weight and increasing the risk of hypoglycemia. All gliptins (sitagliptin, vildagliptin, saxagliptin, linagliptin) can be used as tablets without a need for dose titration. For treating patients with type 2 diabetes, gliptins can primarily be used in combination with metformin.     

降糖药物与恶性肿瘤关系的研究进展

有研究认为糖尿病与某些肿瘤的发生相关[1,2].而长期的糖尿病病程中各种降糖药的使用是否也参与其中,目前还不明确[3].糖尿病伴肿瘤高发的其中一种机制认为[4]:不管是l型糖尿病患者长期使用胰岛素治疗(外源性),还是2型糖尿病患者病程早期有一段胰岛素抵抗的过程(内源性),均可导致高胰岛素血症.高浓度的胰岛素通过胰岛素样生长因子受体(insulin-like growth factor receptors)来促进细胞的有丝分裂,从而导致肿瘤发生.     

Repaglinide: a novel oral antidiabetic agent

Repaglinide is a novel oral antidiabetic agent, marking the development of a new class of drugs for type 2 diabetes. This article examines repaglinide and its position in the treatment of type 2 diabetes.     

Metabolic variations with oral antidiabetic drugs in patients with Type 2 diabetes: comparison between glimepiride and metformin

Patients with Type 2 diabetes (T2DM) are at high risk of morbidity and mortality from cardiovascular complications, and hypoglycaemia increases this risk. Furthermore, other metabolic parameters exacerbate cardiovascular risk in these patients. The aim of the study was to compare the metabolic effects of glimepiride and metformin in patients with T2DM. We evaluated 164 patients with T2DM (80 males, 84 females) in a multicentre, randomised, controlled, open, parallel group study comparing glimepiride with metformin. Eighty-one patients (aged 56+/-10 yr) received glimepiride (3+/-1 mg/d); 83 patients (aged 58+/-9 yr) received metformin (2500+/-500 mg/d). Patients had been diagnosed for < or = 6 months; they were non-smokers; had no hypertension or coronary heart disease; were not taking hypolipidaemic drugs, diuretics, beta-blockers or thyroxin; and had normal renal function. Metabolic parameters were measured after 6 and 12 months of treatment. Glimepiride significantly lowered lipoprotein(a) [Lp(a)] and homocysteine levels (HCT) at 6 and 12 months. Both glimepiride and metformin lowered plasminogen activator inhibitor Type 1 (PAI-1) at 12 months and significantly improved levels of glycosylated haemoglobin, fasting plasma glucose and post-prandial plasma glucose after 6 and 12 months. Metformin significantly lowered fasting plasma insulin and postprandial plasma insulin. Glimepiride and metformin also reduced levels of other metabolic parameters in patients with T2DM. In particular, glimepiride significantly reduced HCT, Lp(a), and PAI-1 levels, important metabolic risk factors for atherosclerotic vascular disease. These reductions may be owing to improved glucose metabolism, but it cannot be excluded that these drugs have a direct effect on additional metabolic parameters.     

江苏省口服降糖药治疗2型糖尿病患者血糖控制现状

目的 了解江苏省社区口服降糖药治疗的2型糖尿病(T2DM)患者的口服药(OAD)用药情况和血糖控制状况.方法 2013年12至2014年1月,抽取江苏省常熟市和淮安市清河区及淮安区3个调查点,对纳入基本公共卫生服务的2型糖尿病患者进行横断面研究,研究内容包括糖尿病问卷调查、糖尿病患者身体测量和糖化血红蛋白(HbA1c)等实验室指标检测,将单用OAD治疗的2型糖尿病患者纳入研究.结果 单用OAD患者12 318例,平均年龄为(62.97±9.73)岁,平均病程为(6.23±5.18)年,平均HbA1c(7.90士1.80)％,HbA1c达标率34.80％.口服降糖药物使用单药治疗、二联用药比例较高,分别为55.26％和41.93％,三联及以上用药组合比例较少,仅为2.81％;单药治疗中,应用较多的为双胍类(41.77％)、磺脲类(38.39％)和格列奈类(12.49％);联合治疗中双胍类联合磺脲类者为65.85％,双胍类联合格列奈类者为15.48％,其他类为18.67％.单药、二联、三联及以上治疗方案HbA1c达标率分别为39.97％、29.04％及18.79％.结论 在中国应用口服药的T2DM患者中血糖控制达标率低,应进一步加强糖尿病管理,及时改变治疗方案,积极开展综合措施有效改善患者血糖控制状况.     

Antidepressant drugs: additional clinical uses

Three decades of psychiatric practice with tricyclic, tetracyclic, and heterocyclic antidepressants have shown that these drugs are effective not only for major depression, endogenous depression in particular, but also for a range of other disorders. Tricyclic and other antidepressants are now used to treat enuresis and attention-deficit disorders in children, bulimia and anorexia nervosa, panic disorder, posttraumatic stress disorder, obsessive-compulsive disorder, chronic pain, migraine, and peptic ulcer disease. As with some of the antidepressants, the body of literature on the relationship between clinical response in these diseases and plasma or serum levels of the drugs is not complete or well understood, but for some of these disorders, sufficient preliminary serum level data are available to take advantage of therapeutic drug monitoring as an adjunct to treatment. Therapeutic monitoring can be particularly important where studies indicate that successful therapy occurs at blood levels substantially different from those used to treat depression. This paper presents a brief overview of antidepressant treatment of these disorders, focusing on the available pharmacologic data related to serum level measurements and their relation to clinical response.