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餐后血糖增高型2型糖尿病藥物干預的研究及臨床實施( 三 )


二肽基肽酶-4(DPP-4)抑制劑
DPP-4抑制劑通過抑制DPP－4（負責降解GLP1的酶）的活性來維持體內GLP1水平 。其刺激胰島素依賴性胰島素分泌 ， 抑制胰高血糖素釋放 ， 延緩胃排空 ， 增加飽腹感 。目前 ， 磷酸西他列汀是第一個上市的DPP-4抑制劑 。DPP-4抑制劑能通過GLP-1刺激胰島素分泌而降低餐后血糖 ， 這種胰島素分泌是葡萄糖依賴性的 ， 在血糖回調之后GLP-1本身也降低 ， 因此低血糖風險小 。該藥不會有服藥后體重增加的擔心 ， 患者更容易接受[10] 。
二肽酶-4（DPP-4）抑制劑和胰高血糖素樣肽（GLP-1）衍生物是近年來研發的較新的控制餐后血糖的藥物 ， 但這類藥物的有效性和安全性尚待更多臨床試驗來評價 。
其他口服降糖藥物
其他口服降糖藥物既可降空腹血糖也可降低餐后血糖 。二甲雙胍主要通過抑制肝糖原的輸出降低空腹血糖 ， 但也有降低餐后血糖的作用 。噻唑烷二酮類藥物為胰島素增敏劑 ， 可通過改善外周組織對胰島素的利用降低餐后血糖 。磺脲類對餐后血糖的降低作用強于二甲雙胍和噻唑烷二酮類藥物 ， 因為它可直接刺激胰島素分泌降低餐后血糖 。但是大部分磺脲類藥物尤其是老的磺脲類如優降糖對胰島素第一時相的刺激作用甚微 ， 選擇性降低餐后血糖作用較弱[6] 。
參考文獻
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[2] The DECODE study group. European Diabetes Epidemiology Group. Diabetes Epidemiology: Collaborative analysis Of Diagnostic criteria in Europe. Lancet. 1999 Aug 21;354(9179):617-21.
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[4] Hanefeld,et al. Risk factors for myocardial infarction and death in newly detected NIDDM: the Diabetes Intervention Study, 11-year follow-up. Diabetologia. 1996 Dec;39(12):1577-83.
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[6]  Tibaldi J.Importance of postprandial glucose levels as a target for glycemic control in type 2 diabetes.South Med J. 2009 Jan;102(1):60-6.
[7] ] Field BC. et al. Bowels control brain: gut hormones and obesity. Nat. Rev. Endocrinol. 2010 ;6(8):444-53.
[8]Bastyr EJ 3rd,et al. Therapy focused on lowering postprandial glucose, not fasting glucose, may be superior for lowering HbA1c. IOEZ Study Group. Diabetes Care. 2000 23(9):1236-41.
(9)  Briones M, Bajaj M. Exenatide: a GLP-1 receptor agonist as novel therapy for Type 2 diabetes mellitus. Expert Opin Pharmacother 2006; 7(8):1055-1064.
【餐后血糖增高型2型糖尿病藥物干預的研究及臨床實施】(10)  Ahren B, Schmitz O. GLP-1 receptor agonists and DPP-4 inhibitors in the treatment of type 2 diabetes. Horm Metab Res 2004; 36(11-12):867-876.