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特殊人群患2型糖尿病的降糖药物选择策略
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| 篇名： | 特殊人群患2型糖尿病的降糖药物选择策略 |
| TITLE： | Selection strategies of hypoglycemic drug for special population with type 2 diabetes mellitus |
| 摘要： | 患2型糖尿病（T2DM）的特殊人群因年龄、性别、生理和病理状态的不同，在药物治疗方面与普通T2DM患者存在明显差异。本文根据最新循证医学证据，系统综述了T2DM合并症或并发症患者、老年患者、儿童患者、妊娠期/哺乳期妇女等特殊人群的降糖药物选择策略。在制定T2DM特殊人群的个体化降糖治疗方案时，医师需根据其不同特征，依据最新循证医学证据，合理选用降糖药物，从而精准降糖，并预防和延缓糖尿病并发症的发生，例如对于合并动脉粥样硬化性心血管疾病、心力衰竭、肾病、肝病的T2DM患者，可在二甲双胍基础上加用钠-葡萄糖共转运蛋白2抑制剂或胰高血糖素样肽1受体激动剂；对于合并胃轻瘫的T2DM患者，建议使用胰岛素；对于合并高尿酸血症或痛风的T2DM患者，应优先选用兼有降尿酸作用的降糖药物，并慎用胰岛素；对于合并骨质疏松症的T2DM患者，应选用不影响骨代谢或有骨保护作用的降糖药物；对于T2DM老年患者，建议优先选择低血糖风险较低的药物单用或联合使用。 |
| ABSTRACT： | The special population with type 2 diabetes mellitus（T2DM）are different from the ordinary T 2DM patients in terms of drug treatment due to age ，gender，physiological and pathological status . Based on the latest evidence of evidence -based medical evidence ，this article systematically reviews the selection strategies of hypoglycemic drug in special population such as T2DM patients with complications ， elderly patients ， children patients ， pregnant/lactating women ， etc. To formulate an individualized hypoglycemic treatment plan for T 2DM special population ，it is necessary to reasonably select hypoglycemic drugs according to their different characteristics and the latest evidence -based medical evidence ，so as to precisely reduce blood sugar and prevent and delay the occurrence of diabetic complications . For example ，for T 2DM patients with atherosclerotic cardiovascular disease，heart failure ，kidney disease and liver disease ，sodium glucose co -transporter 2 inhibitors or glucagon-like peptide 1 receptor agonists should be used additionally on the basis of metformin ；for T 2DM patients with gastroparesis ，insulin is recommended ；for T2DM patients with hyperuricemia or gout ，hypoglycemic drugs with uric acid lowering effects should be preferred ，and insulin should be used with caution ；for T 2DM patients with osteoporosis ，hypoglycemic drugs that do not affect bone metabolism or have bone protection effects should be selected ；for the elderly patients with T 2DM，it is recommended to give priority to the drugs with low risk of hypoglycemia alone or in combination . |
| 期刊： | 2022年第33卷第20期 |
| 作者： | 葛金华，吕娜，冯志海 |
| AUTHORS： | GE Jinhua ，LYU Na，FENG Zhihai |
| 关键字： | 2型糖尿病；特殊人群；降糖药物；选择策略 |
| KEYWORDS： | type 2 diabetes mellitus ；special population ；hypoglycemic drugs ；selection strategy |
| 阅读数： | 209 次 |
| 本月下载数： | 6 次 |
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