肥胖第2型糖尿病患者之減重治療

Weight Reduction Therapy in Obese Patients with Type 2 Diabetes Mellitus

陳建良(Chien-Liang Chen) ； 何志聰(Chih-Tsueng He) ； 林自強(Tzu-Chiang Lin) ； 張兩溉(Leang-Kai Chang)

《內科學誌》 18卷6期 (2007/12) Pp. 322-331

https://doi.org/10.6314/JIMT.2007.18(6).03

摘要

近年來肥胖有逐浙增加的趨勢，過多的腹部脂肪組織會分泌許多脂肪細胞素(adipokines)，常造成慢性發炎及胰島素阻抗，容易導致第2型糖尿病及心血管疾病的發生。研究顯示只要能減少體重5~10%，就可以明顯改善血糖、血壓、血脂的控制，以及減少肥胖相關疾病之罹病率與死亡率。傳統的非藥物治療方式，例如飲食控制、運動及改善生活型態等，經常無法達到成效也很難維持。選用適當的抗肥胖藥物(anti-obesity agents)輔助治療，將提供較理想的減重效果。美國食品藥物管理局(Food and Drug Administration, FDA)只核准了orlistat及sibutramine兩種抗肥胖藥物，使用在肥胖第2型糖尿病患者，除了有減重的效果外，對於改善血糖控制及血脂異常也有幫助。最近新一類的抗肥胖藥物rimonabant已研發出來，是一種選擇性的類大麻受體(cannabinoid-1 receptor)的阻斷劑，已經歐盟藥品審核機關(The European Agency for the Evaluation of Medicinal Products, EMEA)核准上市使用。臨床試驗除了有減重效果外，還可以明顯改善心臟代謝(cardiometabolic)之危險因子。第2型糖尿病患者，及早診斷與適當的治療肥胖是相當重要的，飲食控制與適度的運動等治療性的生活型態改變(therapeutic lifestyle changes, TLC)必須持之以恆，必要時選用適當的抗肥胖藥物輔助治療，將提供較理想的減重效果。

關鍵字

脂肪細胞素 ； 抗肥胖藥物 ； 類大麻受體 ； 治療性的生活型態改變

並列摘要

The prevalence of obesity has been increasing in recent years with excessive visceral adiposity which is associated with higher levels of adipokines leading to chronic inflammation and insulin resistance. It also increases the risk of developing type 2 diabetes mellitus and cardiovascular disease. Studies revealed a reduction of 5-10% of initial body weight can reduce obesity-related morbidity and mortality significantly, including cardiometabolic problems. Nonpharmacotherapy, such as diet control, exercise, and change of lifestyle often fail to achieve and maintain obesity-free. Two anti-obesity drugs, orlistat and sibutramine, approved by the US Food and Drug Administration, are considered to provide not only weight reduction but also improving glycaemic control and lipid profile. Rimonabant, a new class of anti-obesity drug is known as a selective cannabinoid-1 receptor blocker and can effectively reduce body weight and cardiometabolic risk factors in patients with type 2 diabetes in some clinical trials. Timely diagnosis and treatment of obesity are important. Prescribing anti-obesity agent properly, in combination with sustained lifestyle modification efforts, should be considered for patients with obesity.

並列關鍵字

Adipokines ； Anti-obesity agents ； Cannabinoid-1 receptor ； Therapeutic lifestyle changes, TLC