以心臟科醫師的角度來看糖尿病 ... - tsim.org.tw

1 2013 24 12-18.. 1 1 1 1,2 1,2 1,2 1,2 1,2. 1.. 2.. UKPDS (Biguanides) (Sulfonylurea) (Insulin) . Thiazolidinedione (TZD) . Rosiglitazone . ( -glucosidase inhibitors) . DPP-4 (Dipeptidyl Peptidase-IV Inhibitors) 1 . (GLP-1) DPP-4 GLP-1 . (surrogate markers) ACCORD VADT HbA1c .. (A Patient-Centered Approach) . (individualization of treatment) .. HbA1C < 7% DPP-4 . GLP-1 . (Diabetes mellitus). (Anti-diabetic drugs). (Coronary artery disease). (Cardiovascular disease).. 6% 40 80 .. 40 . (HbA1c) 1,2 .. 80708 100 . 012-018_1132 12 2013/3/11 04:41:24. 13. 2 . HbA1c . 3. 2 . 4. 2 4 .. 5,6.. DCCT/ . DEIT . 7-9.. Kumamoto UKPDS (Sulfonylurea).. 10-13. (legacy effect) . (metabolic memory) UKPDS 11,12,27,28 . DCCT/DEIT . 10 . 14,15. 12% . UKPDS . 11.. 13. ACCORD, ADVANCE, . VADT Metformin Gliclazide . 16-19. 29 . 16 . HbA1c Glyburide . 1% HbA1c 18% Metformin 30 . ; 1% HbA1c 14% ADVANCE. 21% 37% ORIGIN.

2 20,21. HbA1c 17,31 ADVANCE . (Prediabetes)4,22 . 23. Gliclazide . 2 HbA1c 5 . DECODE ( ) . 24,25. 2 .. Funagata .. ; (Biguanides). 26. UKPDS 12,27 . 012-018_1132 13 2013/3/11 04:41:25. 14 . Metformin . 32% Rosiglitazone 2010 . 42% 36% . Pioglitazone . 2005 PROACTIVE 36 . Metformin . Pioglitazone . 16% . 2007 . PROACTIVE 37 . Metformin Pioglitazone 28% 37% . 19% . 41% . Meglitinides 2007 Dr. Lincoff . repaglinide nateglinide Pioglitazone 8% 20% . Meglitinides 41% . 38 2008 Dr. Mannucci . gliclazide Meglitinides PROACTIVE . repaglinide Metformin Pioglitazone 70% . 38% 39 . Pioglitazone . 32. Thiazolidinedione .. Thiazolidinedione (TZD) Thiazolidinedione . Thiazolidinedione (TZD) . Dr.. Nissen 2007 Rosiglitazone . 43% . 64% 33 Dr. Mannucci ( -glucosidase 2010 164 inhibitors). Rosiglitazone 10% acarbose miglitol . 6% voglibose -glucosidase inhibitors . 14% 69% . 34. ( Food and . Drug Administration) 2010 Rosiglitazone.

3 Cardiovascular Safety Meta-Analysis . Rosiglitazone 80% 50% 2003 STOP-NIDDM 40 acarbose 35 Dr. Nissen 2010 . Rosiglitazone 28% 53% .. 012-018_1132 14 2013/3/11 04:41:25. 15. 2004 . 41. 7 16,48 . acarbose . 64% 35% HbA1c . 1999 UKPDS acarbose . 42. 2005 : . 43. -glucosidase inhibitors (Body Mass Index, BMI) . -glucosidase . inhibitors (American Diabetes 44. Association) (European Association for the Study of Diabetes) 2012 . DPP-4 (Dipeptidyl Peptidase-IV 49 . Inhibitors) 1 (Glucagon- (A Patient-Centered like peptide-1 analogues, GLP-1 ) Approach) (individualization of treatment) . GLP-1 HbA1c < 7% < 130 mg/dl . < 180 mg/dl .. 45. 2012 Dr. Sun 45 HbA1c . GLP-1 . DPP-4 ( . 2012 Dr. Monami ) . 46. DPP-4 HbA1c ( ) . HbA1c . Figures . TECOS (Sitagliptin, Figure 1 .. 49. NCT00790205) SAVOR-TIMI (Saxagliptin, NCT01107886) EXSCEL (Exenatide, NCT01144338) .. DPP-4 GLP-1 . (surrogate markers)47 .. ACCORD VADT.

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