以心臟科醫師的角度來看糖尿病藥物的使用

Anti-diabetic Drugs from a Cardiologist's Point of View

朱俊源(Chun-Yuan Chu) ； 李文賢(Wen-Hsien Lee) ； 許柏超(Po-Chao Hsu) ； 蘇河名(Ho-Ming Su) ； 林宗憲(Tsung-Hsien Lin) ； 溫文才(Wen-Chol Voon) ； 賴文德(Wen-Ter Lai) ； 許勝雄(Sheng-Hsiung Sheu)

《內科學誌》 24卷1期 (2013/02) Pp. 12-18

https://doi.org/10.6314/JIMT.2013.24(1).02

摘要

Only limited studies have shown that anti-diabetic drugs could reduce the mortality and morbidity associated with coronary artery disease (CAD), of which is the United Kingdom Prospective Diabetes Study (UKPDS) regarding with the use of biguanides, sulfonylurea, and insulin in the long-term follow-up. Thiazolidinedione (TZD) is controversial especially when Rosiglitazone associated with an increase in the risk of cardiovascular deaths. There is a lack of consistent conclusions on the cardiovascular outcomes for α-glucosidase inhibitors and further studies are needed. Dipeptidyl Peptidase-IV Inhibitor (DPP-4 inhibitor) and Glucagon-like peptide-1 (GLP-1) are developed recently, which are capable of improving some cardiovascular surrogate markers. ACCORD and VADT studies do not support the intensive sugar control with a target HbA1c of 6.5% or less, which may increase the risk of hypoglycemia and mortality without any decrease in cardiovascular disease (CVD). Management of hyperglycemia should be based on a patient-centered approach with emphasis on individualization of treatment. To reduce CVD from a cardiologist's point of view, a simply target HbA1c of 7.0% is adequate for patients with high cardiovascular risk or diagnosed CVD and the biguanides is preferred. For DPP-4 and GLP-1, further research is required to evaluate the potential benefit in CVD.

關鍵字

糖尿病 ； 糖尿病藥物 ； 冠狀動脈疾病 ； 心血管疾病

並列摘要

Only limited studies have shown that anti-diabetic drugs could reduce the mortality and morbidity associated with coronary artery disease (CAD), of which is the United Kingdom Prospective Diabetes Study (UKPDS) regarding with the use of biguanides, sulfonylurea, and insulin in the long-term follow-up. Thiazolidinedione (TZD) is controversial especially when Rosiglitazone associated with an increase in the risk of cardiovascular deaths. There is a lack of consistent conclusions on the cardiovascular outcomes for α-glucosidase inhibitors and further studies are needed. Dipeptidyl Peptidase-IV Inhibitor (DPP-4 inhibitor) and Glucagon-like peptide-1 (GLP-1) are developed recently, which are capable of improving some cardiovascular surrogate markers. ACCORD and VADT studies do not support the intensive sugar control with a target HbA1c of 6.5% or less, which may increase the risk of hypoglycemia and mortality without any decrease in cardiovascular disease (CVD). Management of hyperglycemia should be based on a patient-centered approach with emphasis on individualization of treatment. To reduce CVD from a cardiologist's point of view, a simply target HbA1c of 7.0% is adequate for patients with high cardiovascular risk or diagnosed CVD and the biguanides is preferred. For DPP-4 and GLP-1, further research is required to evaluate the potential benefit in CVD.

並列關鍵字

Diabetes mellitus ； Anti-diabetic drugs ； Coronary artery disease ； Cardiovascular disease