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首页> 外文期刊>Diabetes, obesity & metabolism >What are the preferred strategies for control of glycaemic variability in patients with type 2 diabetes mellitus?
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What are the preferred strategies for control of glycaemic variability in patients with type 2 diabetes mellitus?

机译:控制2型糖尿病患者的血糖变异性的首选策略是什么?

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The aim of therapy in type 2 diabetes in terms of blood glucose control is to reduce to target levels HbA1c and to reduce glycaemic variability in order to avoid both hypoglycaemia and wide excursions of postprandial glucose. The first approach to reduce glycaemic variability should consider a dietary and behavioural approach aiming to limit the glycaemic index and the glycaemic load of food and the prescription and implementation of a physical activity plan appropriate for the subject. From the pharmacological point of view, the diabetes specialist has now a much richer therapeutic armamentarium. The therapeutic algorithms can help the physician to choose the most appropriate drug. The traditional approach involves: i) metformin, acting mainly on fasting blood glucose; ii) sulphonylureas, that have shown a number of drawbacks, including the high risk of hypoglycemia; iii) pioglitazone, with a substantial effect on fasting and postprandial glucose and a low risk of hypoglycaemia; iv) insulin, that can be utilized with the basal or prandial approach. The new drugs belonging to the class of dipeptidyl peptidase-4 inhibitors have shown the reduction of postprandial glucose, a neutral effect on weight increase, a good safety profile and preliminary positive cardiovascular effects. When excess weight prevails, the glucagon-like peptide-1 agonists may be the preferred choice for their effect on weight reduction, reduction of hyperinsulinism and glycaemic variability.
机译:就血糖控制而言,治疗2型糖尿病的目的是将HbA1c降至目标水平并降低血糖变异性,以避免低血糖症和餐后血糖的广泛波动。减少血糖变异性的第一种方法应考虑饮食和行为方法,旨在限制食物的血糖指数和血糖负荷以及适合该受试者的处方和身体活动计划的实施。从药理学角度来看,糖尿病专科医生现在拥有更加丰富的治疗性武器装备。治疗算法可以帮助医生选择最合适的药物。传统方法包括:i)二甲双胍,主要作用于空腹血糖; ii)磺脲类药物已显示出许多缺点,包括低血糖的高风险; iii)吡格列酮,对禁食和餐后血糖有实质性影响,低血糖风险低; iv)胰岛素,可以与基础或膳食方法一起使用。属于二肽基肽酶-4抑制剂类别的新药显示出餐后葡萄糖减少,体重增加具有中性作用,良好的安全性和初步的积极心血管作用。当普遍存在超重时,胰高血糖素样肽-1激动剂可能对减轻体重,减少高胰岛素血症和血糖变异性有影响,因此是首选。

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