糖尿病治療

治療目標:

Table 344-8 Treatment Goals for Adults with Diabetesa

Index Goal 血糖b   A1C (primary goal) <7.0%c   Pre-prandial capillary plasma glucose 70–130 mg/dL   Peak 飯後1-2h capillary plasma glucosed <180 mg/dL 血壓 <130/80 血脂e   LDL 100 mg/dL   HDL 40 mg/dL in men; 50 mg/dL in women   TG 150 mg/dL

^a recommended by ADA; goals should be individualized for each patient (see text). Goals may be different for certain patient populations.  

^bA1C is primary goal.  

^cNormal range for A1C: 4.0–6.0% (DCCT-based assay). 

^dOne–two hours after beginning of a meal.  

^eIn decreasing order of priority. Source: Adapted from American Diabetes Association, 2011.

 A1c < 6.5 : if 無其他疾病, 或無低血糖風險
 A1c < 7 : 有合併其他疾病, 且有低血糖風險

糖尿病藥物

	MET	DPP4-i	GLP-1RA	TZD	AG-i	Colsvl	BCR-QR	SU/GLN	Insulin	SGLT-2	Praml
低血糖	X	X	X	X	X	X	X	中-重/輕	中-重	X	X
體重	微降	X	輕	胖	X	X	X	胖	胖	輕	輕
腎/GU	忌CKD3B,4,5	需調ds*1	Exenatide 忌CCr<30	體液滯留	X	X	X		體液滯留	感染	X
GI Sx	中度	X	中度	X	中度	輕度	中度	X	X	X	中度
CHF	X	X	X	中度	X	X	X	X	X	X	X
CVD	益處	X	X	X	X	X	安全	?	X	X	X
骨	X	X	X	中度流失	X	X	X	X	X	流失?	X

*1: linagliptin    縮寫: Colesvelam  Bromocriptine QR

AACE 2013 糖尿病治療指引

改變生活方式/ 減重
來診/住院A1c 7.5以下	7.5-9		9以上
單1藥  (3月內>6.5 ->dual)   Metformin   GLP1-RA   DPP4-i   AG-i   SGLT-2   TZD   SU/GLN	2藥  (3個月未達標->Triple) Metformin (或其他首選藥) +  GLP1-RA  DPP4-i  TZD  SGLT-2  Basal insulin  Colesevelam  Bromocriptine QR  AG-i  SU/GLN	3藥   (3個月未達標->insulin) Metformin (或其他首選藥) +  GLP1-RA  TZD  SGLT-2  Basal insulin  DPP4-i  Colesevelam  Bromocriptine QR  AG-i  SU/GLN	無症狀: Dual or triple tx 有症狀:   Insulin ± 其他藥

Basal insulin 治療		Intensify insulin Tx (prandial control)
A1c < 8	A1c > 8	+ GLP-1 RA (or DPP4-i)	+ Prandial insulin
TDD 0.1-0.2 U/Kg	TDD 0.2-0.3 U/Kg		TDD 0.3-0.5 U/Kg   50% basal insulin   50% prandial insulin
每2-3天調整劑量至達標: Fixed regimen: ↑TDD by 2U 可調式regimen:  FBG >180: + 4U    140-180: 2U    110-139: 1U *低血糖: ↓TDD by    BG < 70: 10-20%    BG < 40: 20-40% *開始用basal insulin後, 考慮拿掉或減少SU劑量 *血糖目標:   A1c <7 (對大多數T2DM)   餐前/禁食: < 110		*較不desirable: NPH and RI or premixed insulin 每2-3天調整劑量至達標: Fixed regimen: ↑TDD by 2U 可調式regimen:  FBG >180: + 4U    140-180: 2U    100-139: 1U 高血糖:  *if 2h-postprandial or next preprandial glucose > 180:    ↑prandial dose 10%  *premixed: ↑TDD 10%, if fasting/preprandial BG >180 低血糖:  *If 空腹AM 低血糖:↓basal insulin  *If 夜間低血糖:↓basal and/or pre-supper or pre-evening snack short/rapid acting insulin  *if白天餐間低血糖: previous premeal short/rapid-acting insulin