糖尿病的中西药物治疗进展

糖尿病（ＤＭ）是与环境因素、遗传因素、病毒感染和自身免疫有关的一种常见内分泌疾病。ＤＭ的病程长，常伴有动脉粥样硬化性心及脑血管疾病、糖尿病肾病、神经系统病变、眼部病变等多种并发症，这些并发症严重地危害患者的身心健康。在坚持控制饮食及体育疗法的基础上，人类一直在寻求选择性高、不良反应小的中西药物，以期能达到理想的临床治疗效果。现将近几年文献资料中ＤＭ治疗的中西药物进展状况作一综合报道。１西药的新技术、新剂型 目前ＤＭ的西药治疗仍以胰岛素、磺脲类、双胍类以及α－糖昔酶抑制剂为主，只是在制药技术以及剂…     

糖尿病的临床药物治疗进展

糖尿病是一种与遗传基因相关 ,内源性胰岛素相对或绝对不足而引起的糖、脂肪、蛋白质代谢紊乱的疾病。临床上将糖尿病分为胰岛素依赖型 (IDDM)及非胰岛素依赖型 (NIDDM)。糖尿病发病率有迅速增长的趋势 ,它是继心血管疾病、癌症之后致残率、致死率最高的第三大疾病。世界卫生组织已将防治糖尿病列为全球保护人类健康的重要问题之一。糖尿病的治疗方法主要有饮食疗法、药物疗法和运动疗法。本文就糖尿病的药物治疗进展情况进行综述。1　口服降糖药口服降糖药是目前治疗NIDDM的主要方法。现在认为NIDDM与下列因素有关 :( 1)胰岛β细胞…     

浅谈糖尿病的药物治疗

糖尿病是由遗传和环境因素相互作用而引起的常见病,临床以高血糖为主要标志,常见症状有多饮、多尿、多食以及消瘦等。糖尿病分1型糖尿病和2型糖尿病。其中1型糖尿病多发生于青少年,因胰岛素分泌缺乏,必须依赖胰岛素治疗维持生命。2型糖尿病多见于30岁以后中、老年人,其胰岛素的分泌量并不低甚至还偏高,病因主要是机体对胰岛素不敏感（即胰岛素抵抗）。治疗糖尿病的药物可概括为两大类：口服降糖药和胰岛素。本文就糖尿病治疗药物作简要介绍。     

糖尿病治疗过程中低血糖反应26例

低血糖是糖尿病诊治过程中常见急症之一 ,本文分析糖尿病诊治过程中发生的低血糖反应 2 6例。报告如下 :1　临床资料1.1　一般资料　 2 6例患者均符合 1985年 WHO制定的标准诊断为 2型糖尿病 ,其中男 9例 ,女 17例。4 0岁以下 1例 ,4 5岁～ 5 5岁 6例 ,6 0岁～ 70岁 14例 ,70岁以上 5例。病程1a2例 ,1a～ 4 a3例 ,5 a～ 10 a12例 ,10 a以上 9例。老年人或病程长者诊治过程中容易发生低血糖。并发症情况 :并发心血管疾病 13例 ,糖尿病肾病肾功能不全 9例 ,感染 9例次 ,糖尿病周围神经病变 4例 ,脑梗死 2例 ,糖尿病非酮症高渗性昏迷 1例。1.…     

药物降糖是糖尿病治疗的重点

糖尿病是一组以胰岛素分泌缺陷和(或)胰岛素作用不足所致高血糖为特征的代谢紊乱。中国是糖尿病大国,据统计,目前我国现有糖尿病患者已突破1亿,我国几次大型糖尿病流行病学调查显示,在过去的30年中,我国糖尿病患病率上升了10倍。药物治疗是糖尿病治疗的重点。除小部分经饮食治疗和运动治疗就能控制病情的Ⅱ型糖尿病病人以外,都需要进行药物治疗。常见的药物治疗方式有:胰岛素治疗、口服降糖药治疗。     

糖尿病口服降糖药治疗

糖尿病治疗包括五个方面,即糖尿病教育与心理治疗、饮食治疗、运动治疗、药物治疗与糖尿病监测。糖尿病口服药物治疗是糖尿病综合治疗的重要环节。糖尿病患者常用的药物包括口服降糖药、其他口服药物和中医药。这里主要谈谈糖尿病的口服降糖药治疗问题。 常用口服降糖药     

磺脲类口服降糖药物继发失效的诊治

磺脲类口服降糖药物继发失效的诊治冯文忠糖尿病治疗的目的是使空腹血糖（ＦＢＳ）达到或接近正常水平（４．４～７．７ｍｍｏｌ／Ｌ），消除临床症状，提高生活质量，防止各种慢性并发症。非胰岛素依赖型糖尿病（ＮＩＤＤＭ）３０％～５０％通过饮食控制和运动可以达到目...     

药物治疗糖尿病的临床应用进展

糖尿病是一种常见的内分泌代谢病[1],是一种糖、蛋白和脂肪代谢障碍疾病,其原因众多,但主要的失调是胰岛素分泌或生成异常.糖尿病在当今世界上已属常见病,预测到2010年将增至2～4亿人,成为人类第5位死亡原因[2].糖尿病可分为胰岛素依赖性(又称Ⅰ型)及非胰岛素依赖性糖尿病(又称Ⅱ型).治疗糖尿病的药物主要有胰岛素、磺酰脲类、双胍类、葡萄糖苷酶抑制剂、胰岛素增敏剂及新一代胰岛素促泌剂;另外,中药治疗糖尿病的临床效果也引人注目.     

新生儿糖尿病的磺脲类药物治疗

新生儿糖尿病(Neonatal Diabetes Mellitus,NDM)是一种少见的特殊类型糖尿病,临床可分为新生儿暂时性糖尿病(Transient neonatal diabetes,TNDM)和新生儿永久性糖尿病(Permanent neonatal diabetes,PNDM)两类[1]。NDM最早由Kitsell[2]于1852年报道,NDM常发生于生     

格列吡嗪控释片治疗继发性磺脲类降糖药失效2型糖尿病的疗效

目的 :观察格列吡嗪控释片治疗继发性磺脲类降糖药失效 2型糖尿病的疗效。方法 :选取继发性磺脲类降糖药失效的 2型糖尿病患者 6 4例 ,随机分为 2组 ,各 32例。治疗组予格列吡嗪控释片治疗 ,对照组予格列吡嗪速效片治疗 ,观察 8wk(治疗组分成 4wk剂量调整期 ,4wk维持期 )。治疗前后行 2次口服糖耐量试验 (OGTT)和胰岛素释放试验 ,计算胰岛素释放指数 (IRG)和胰岛素敏感指数 (ISI) ;比较 2组治疗前后血糖 ,血胰岛素 ,IRG ,ISI和临床疗效。结果 :与治疗前比较 ,治疗组治疗后血糖水平下降 ,ISI增高 ,P <0 .0 1;但胰岛素水平及IRG与服药前无显著性差异。对照组各指标治疗前后均无显著性差异。治疗组总有效率 (5 6 .2 % )显著高于对照组 (9.3% ) ,P <0 .0 1,且无明显不良反应发生。结论 :格列吡嗪控释片可改善继发性磺脲类降糖药失效的 2型糖尿病患者胰岛素敏感性及血糖控制 ,可作为继发性磺脲类降糖药失效患者的治疗药物     

Drug treatment of hypertension in older patients with diabetes mellitus

Introduction: Hypertension is more prevalent in the elderly (age>65 years) diabetic population than in the general population and shows an increasing prevalence with advancing age. Both diabetes mellitus (DM) and hypertension are independent risk factors for cardiovascular (CV) related morbidity and mortality. Optimal BP targets were not identified in elderly patients with DM and hypertension.

Areas covered: In this review article, the authors briefly discuss the pathophysiology of hypertension in elderly diabetics, present evidence with various antihypertensive drug classes supporting the treatment of hypertension to reduce CV events in older diabetics, and then discuss the optimal target BP goals in these patients.

Expert opinion: Clinicians should have a BP goal of less than 130/80 mm in all elderly patients with hypertension and DM, especially in those with high CV-risk. When medications are required for optimal BP control in addition to lifestyle measures, either thiazide diuretics, angiotensin-converting-enzyme inhibitors, angiotensin receptor blockers, or calcium channel blockers should be considered as initial therapy. Combinations of medications are usually required in these patients because BP control is more difficult to achieve in diabetics than those without DM.     

糖尿病合并血脂代谢异常的药物治疗

2型糖尿病合并血脂代谢异常血脂谱的特点是血清三酰甘油(TG)及小而密低密度脂蛋白-胆固醇(sLDL-C)升高,高密度脂蛋白-胆固醇(HDL-C)降低。治疗措施包括生活方式干预、控制高血糖和调脂药物应用3个方面。治疗的首要目标是降低低密度脂蛋白-胆固醇(LDL-C),调脂药物首选他汀类,其他尚有依折麦布、血脂康、多廿烷醇、胆酸螯合剂及普罗布考等。单纯TG升高或TG明显升高(>4.52 mmol.L-1)患者,选择以降低TG为主的贝特类、烟酸类及其衍生物和Omega-3(ω-3)脂肪酸等药物。HDL-C低下患者除了生活方式干预外,可选择以烟酸类为主的调脂药物治疗。糖尿病合并混合型血脂异常患者的处理是在严格掌握适应症的情况下,选择以他汀类为主与其他调脂药物联合应用方案;非诺贝特对治疗该类血脂异常患者具有一定的优势。     

Challenges for the treatment of diabetes mellitus

The present review summarizes the existing literature data regarding the development of newer categories of antidiabetic agents, their mechanism of action and their clinical importance. In this paper, a review of the recent patents for the treatment of diabetes will be presented. In recent years significant achievements have been done, including the development of SGLT2 inhibitors, glucokinase activators as well as the role of free fatty acids and bile acid metabolism in the treatment of diabetes are reviewed.     

格列齐特治疗非胰岛素依赖型糖尿病

观察６０例Ⅱ型糖尿病病人服用格列齐特的国产与法国产２种制剂的近期疗效。结果：两者对Ⅱ型糖尿病均有明显降血糖作用，不良反应轻微，在其他磺酰脲类药物治疗无效时，格列齐特仍可有明显疗效。无论是２组组间比较还是自身对照比较，两者的降糖作用，有效剂量，维持剂量和疗效反应都十分相近。     

The treatment of type 1 diabetes mellitus with agents approved for type 2 diabetes mellitus

Introduction: The management of type 1 diabetes remains a challenge for clinicians. Current practice is to administer insulin analogues to best mimic normal physiological insulin profiles. However, despite our best efforts the majority of individuals with type 1 diabetes continue to suffer from suboptimal glucose control, significant hypoglycemia and microvascular tissue complications of the disease. There is thus a significant unmet need in the treatment of T1DM to obtain better glycemic control.

Areas covered: We discuss the use of α-glucosidase inhibitors, dipeptidyl-peptidase inhibitors, glucagon-like peptide 1 agonists, biguanides, thiazolidinediones and sodium glucose co-transporter 2 inhibitors in individuals with T1DM.

Expert opinion: Non-insulin therapies present a unique and exciting adjunctive treatment for individuals with type 1 diabetes. Although data are scarce, the classes of medications discussed help to lower glucose, decrease glycemic excursions and in some cases improve body weight, along with allowing dose reductions in total daily insulin. Glucagon-like peptide 1 agonists and sodium glucose co-transporter 2 inhibitors, in particular, have been demonstrated to provide clinical improvements in individuals with T1DM and we feel their use can be explored in obese, insulin-resistant patients with T1DM, those with frequent and significant glycemic excursions or individuals with persistently elevated hemoglobin A1c.     

Ketoconazole enantiomer for the treatment of diabetes mellitus

The impact of hypercortisolism on multiple metabolic conditions is well recognized; the metabolic manifestations of Cushing's syndrome overlap with those seen in type 2 diabetes and the metabolic syndrome. Ketoconazole (KTZ), a widely used antifungal agent that inhibits various enzymes in adrenal cortisol synthesis, is effective in treating hypercortisolemia, but its use is limited by toxicities. KTZ is a racemic compound of two cis-enantiomers: (2R,4S)-(+)-KTZ and (2S,4R)-(-)-KTZ. The consideration of an enantiomer with selective effect but minimal metabolic toxicity has driven the development of DIO-902 ([2S,4R]-[-]-KTZ) for the treatment of patients with type 2 diabetes and the metabolic syndrome. To evaluate the safety profile and effect of KTZ enantiomer, (2S,4R)-(-)-KTZ, on cortisol production, glycemia, and lipid profiles in patients with type 2 diabetes. Review of multiple published studies and examination of preliminary results from a Phase IIb clinical trial. Twelve weeks of treatment with DIO-902 resulted in reduced levels of HbA1c, FPG, total and LDL cholesterol as well as weight loss and decreased BP. In a previously conducted Phase IIa study, C-reactive protein levels decreased with DIO-902 treatment. Unfortunately, the development of this agent has been terminated due to unacceptable safety profiles.     

聚类法分析糖尿病的药物治疗状况

目的探讨糖尿病的药物治疗的研究热点。方法检索2014-2016年Pub Med数据库中收录的有关糖尿病药物治疗的文献,并通过书目共现分析系统(BICOMB),提取分析文献的主要主题词+副主题词,建立高频主要主题词+副主题词的词篇矩阵,最终导入SPSS 19.0中进行聚类分析。结果共检索文献7 505篇,共抽取主要主题词+副主题词6 580个,截取高频主要主题词+副主题词共37个,最后聚类分析为5类。结论糖尿病药物治疗的研究热点主要集中在5个方面:11型糖尿病投药剂量以及血糖监测研究;22型糖尿病药物疗法与新的特效药的治疗应用;32型糖尿病并发症的药物治疗;4实验性糖尿病神经病变的药物治疗;5糖尿病眼部病变的药物疗法。     

Glyburide for the treatment of gestational diabetes mellitus

Insulin is the traditional treatment for gestational diabetes mellitus (GDM) unresponsive to dietary interventions. Until recently, oral hypoglycemic drugs had been contraindicated due to concerns regarding teratogenicity and the possibility of neonatal hypoglycemia. In contrast to other sulfonylurea drugs, in vitro and in vivo investigations have demonstrated very low transplacental transport of glyburide to the fetal circulation. The mechanisms preventing glyburide from crossing the human placenta are not completely understood. A combination of extremely high protein binding and a relatively short elimination half-life might partially explain it. It has also been demonstrated that glyburide is effluxed from the fetal to the maternal circulation by the breast cancer resistance protein (BRCP) and the human multidrug resistance protein 3 (MRP3). Since 2000, several studies have reported an 80-85% success rate of glyburide treatment. However, some authors have noticed glyburide-related increased risk of preeclampsia, macrosomia, neonatal hypoglycemia, admission to a neonatal intensive care unit and need for phototherapy. These possible maternal as well as neonatal adverse outcomes warrant further investigations. Until that time, the use of glyburide should remain inadvisable in pregnancy.     

糖尿病下肢血管病变药物治疗综述

糖尿病下肢血管病变为糖尿病常见的慢性并发症之一。及早给予药物治疗不仅能有效缓解症状,还能积极预防血管并发症的发生,延缓疾病的发展,降低截肢率,对糖尿病下肢血管病变的预后具有重要意义。本文综述糖尿病下肢血管病变的药物治疗现状。