ヤクブツ チリョウ ニツイテ
Pharmacological therapy in diabetes mellitus
Fujinaka, Yuichi Department of Medicine and Bioregulatory Sciences, Institute of Health Biosciences, The University of Tokushima Graduate School
Pharmacological therapy in diabetes mellitus has been changing in the last decade. Because conventional therapy for type 2 diabetes patients using sulfonylurea often caused secondary failure during long-term glycemic control, it was recognized that alpha-glucosidase inhibitors, metformin and thiazolidinedione which had hypoglycemic effects without exhaustion of beta cell function were beneficial. These drugs have efficacy not only for lowing plasma glucose concentration but for prevention of diabetes progression. Several clinical studies showed that angiotensin converting enzyme inhibitors, angiotensin Ⅱ receptor blockers and statins also had effects to prevent from type 2 diabetes. When we select diabetic therapy, especially to protect against the occurrence of macrovascular complications, it should be considered that type 2 diabetes has an aspect of metabolic syndrome. On the other hand, insulin therapy was reevaluated because of data from UKPDS and DCCT which demonstrated normoglycemia with intensive insulin therapy was critical goal to reduction in risk of diabetic complications. Very-rapid-acting insulin may be helpful for introduction of insulin therapy. To keep better glucose control, insulin may be considered until beta cell function is exhausted.
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