2017年ACP《2型糖尿病口服药物治疗临床实践指南》解读

摘要

As the incidence of type 2 diabetes has been on the rise,and oral administration of hypoglycemic drugs has been the main means for treating the disease,studying and popularizing the guide to the oral medication for type 2 diabetes is helpful to the prevention and treatment of the disease.This article is about an interpretation of Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus:a Clinical Practice Guideline Update from the American College of Physicians (hereinafter referred to as the guideline) published in 2017.Compared with the guideline of 2012,in the new guideline,the characteristics and types of oral hypoglycemic drugs for type 2 diabetes were further summarized,supplemented by the latest found clinical evidences,and the following recommendations were put forward:first,when oral pharmacologic therapy is needed,clinicians should prefer metformin to improve the fasting blood glucose level;second,when there is a need for adding a second agent to metformin for further improving the blood glucose control,clinicians can select sulfonylureas,thiazolidinediones,SGLT-2 inhibitors or DPP-4 inhibitors.All of these will lead to the improvement of rational choice of oral drugs for adults with type 2 diabetes mellitus.%2型糖尿病发病率目前仍然呈上升趋势,口服降糖药物仍是目前2型糖尿病患者治疗的最主要手段,学习和推广2型糖尿病口服药物治疗指南有利于提高2型糖尿病的防治水平.本文对美国医师协会(ACP)最新发布的《2型糖尿病口服药物治疗临床实践指南》(以下简称《指南》)的要点进行了解读,并与2012年版《指南》比较,进一步梳理了2型糖尿病口服降糖药物的种类和特点,补充了新的临床研究证据并提出建议:(1)当需要药物治疗时,临床医生应首选二甲双胍,以改善血糖;(2)在二甲双胍基础上,需要加用另一种口服药物时,临床医生可选择磺脲类、噻唑烷二酮类、钠-葡萄糖协同转运蛋白2(SGLT-2)抑制剂或二肽基肽酶-4(DPP-4)抑制剂中的一种,以进一步改善血糖控制.这为成年2型糖尿病患者口服药物的合理选择提供了依据和建议.