Type 2 diabetes is a multi-gene genetic factors and environmental factors of diseases, defects in insulin secretion of B cells and the pathogenesis of insulin resistance are two major factors in the performance of different patients vary, with a high degree of heterogeneity.
Condition assessment and the choice of a single medication
1. According to patients with high blood sugar caused by defects in the main choice of drug use: evaluation of patients with disorders of glucose metabolism is a major factor in insulin secretion defects in small B cells, or insulin resistance. If the former, sulfonylurea or choose category Nateglinide; If the latter can choose Thiazolidinediones; Postprandial Hyperglycemia alone also can be used α-glucosidase inhibitors; partial obesity and insulin released some suitable metformin; new cases are too high fasting blood glucose can be the beginning of intensive treatment with insulin.
2. If the fasting blood glucose> 14.0mmol / L insulin therapy of choice: for a quick lifting of the state of the toxicity of high blood sugar, it is recommended the application of insulin therapy, when the fasting blood glucose to 11.0mmol / L the following, and their recovery when insulin secretion (which can be measured determine C-peptide) of oral hypoglycemic agents may be changed.
3. According to the results of blood glucose determination to determine the efficacy and dosage adjustment: If the target fasting blood glucose in control, but have not reached the goal of glycosylated hemoglobin should be measured 1 to 2 hours postprandial blood glucose, postprandial blood glucose control to make the 10.1mmol / L following. If the adjustment of the dose of oral hypoglycemic agents, should be based on fasting, postprandial blood glucose and glycosylated hemoglobin to determine, with a view to achieve maximum effect.
Combination of timing and evaluation of
1. New cases of the combination: newly diagnosed patients with type 2 diabetes could be the beginning of single-drug treatment therapy can also be combined. Such as single-drug therapy, dose increases to about 80% of the maximum dose has yet to be achieved as soon as possible to the joint with 2 ~ 3 kinds of oral medication. If the result is not satisfactory, can be added before going to bed with a small dose of insulin. Such as B cells in patients with significantly reduced liver and kidney function or those treated only with insulin.
2. Combination of methods: such as insulin secretion promoting agent (sulfonylurea-type pass out Chennai) classified as a class, and other types of hypoglycemic drugs may be combined.
3. To evaluate the combination therapy consisting of
① sulfonylurea and metformin in conjunction with the application of this is the earliest and most commonly used method, low-cost, high plasma insulin is not increased, regardless of using metformin or sulfonylurea, the effect of the poor and those can be combined to make decline in blood glucose.
② non-sulfonylurea insulin secretion promoting agent and co-sensitizer can be played from the mechanism of their own strengths, the corresponding enhanced hypoglycemic effects, such as types of nateglinide control postprandial hyperglycemia, metformin will enable a further decline in fasting blood glucose.
③ α glucosidase inhibitor drugs in combination with other α glucosidase inhibitor mechanism different from those of other hypoglycemic drugs, does not promote insulin secretion and insulin resistance for non-directly, but by delaying the absorption of carbohydrates and reduce postprandial high blood sugar, all kinds of other drugs are on the complementary role of carbohydrates in diet as the main ingredient (such as the Chinese people) better results.
④ insulin combined with oral hypoglycemic agents used in conjunction with oral hypoglycemic agents yet to be achieved, the insulin can be added, such as the effect of bedtime insulin plus. Or insulin to replace a drug, such as to replace the sulfonylurea and metformin combined. Insulin and sulfonylureas can also be used in conjunction, such as sustained-release tablets at night with sulfonylurea or controlled-release tablets, the day before meals plus insulin or premixed insulin, can reduce the amount of insulin. Insulin can also Thiazolidinediones in conjunction with, but bearing in mind that both may have the adverse reactions
⑤ Metformin and Thiazolidinediones, although the two are combined with insulin sensitizers, but the role of different aspects of and mechanisms, in combination could enhance efficacy, reduce side effects.
In addition, when there are serious complications, such as ketoacidosis, diabetes, advanced renal disease in patients with type 2 diabetes, insulin therapy must be used. Diabetes ultimate cause of death was cardio-and cerebro-vascular complications of diabetes treatment is not only to control blood sugar, but will also take full control of cardiovascular risk factors, such as dyslipidemia, hypertension, obesity, high blood viscosity and a state of chronic inflammation, such as, side can achieve good results.
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