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2型糖尿病に対するインスリン単独療法に添加された経口低血糖剤
Rimke C Vos1, Guy E H M Rutten1
1Julius Center for Health Sciences and Primary Care, Department of General Practice, University Medical Center Utrecht, Utrecht, the Netherlands.
JAMA
|October 20, 2017
まとめ
インスリン療法に硫黄尿素やメトホルミンなどの経口薬を加えると,2型糖尿病患者の血糖コントロールが改善されます. サルフォニル尿素は低血糖症のリスクを増加させましたが,両方の薬剤はヘモグロビンA1cを約1. 0%低下させました.
科学分野:
- 内分泌学
- 代謝 疾患
- 薬理学について
背景:
- 2型糖尿病 (T2DM) の管理には,多くの場合,多面的な治療戦略が必要です.
- インスリン単独治療は,一部のT2DM患者において,最適な血糖コントロールを達成するのに不十分である可能性があります.
- 口服による低血糖剤 (OHAs) は,通常,インスリン療法に併用されます.
研究 の 目的:
- T2DM患者でインスリンに経口低血糖剤を添加する際の効果と副作用を評価する.
- ヘモグロビンA1c (HbA1c) レベルと低血糖事件の発生率への影響を評価する.
主な方法:
- インスリン単独療法と併用療法 (インスリン+OHA) を比較した患者データの遡及分析.
- HbA1cの変化と報告された低血糖事件は,主なアウトカムメートでした.
- 調べられた特定のOHAには,硫黄尿素とメトホルミンが含まれていた.
主要な成果:
- スルフォニル尿素とメトホルミンは,インスリンに添加されたとき,HbA1cを約1. 0%低下させた.
- インスリン療法にサルフォニル尿素を加えたと,低血糖症の発生率が高かった.
- インスリン治療にメトホルミンを加えたとき,低血糖症の有意な増加は観察されなかった.
結論:
- 口服による低血糖薬 (硫黄尿素またはメトホルミン) とインスリン治療を併用すると,T2DM患者におけるHbA1cレベルを効果的に低下させることができます.
- インスリンと併用したメトフォーミンは,スルフォニル尿素と比較して低血糖のリスクに関してより安全な選択肢である.
- 個別的な治療決定は,OHAとインスリンとの組み合わせの有効性と安全性のプロフィールの両方を考慮する必要があります.
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