Tip 2 diabetes mellitusta kombinasyon tedavisi
Tip 2 diabetes mellitusta kombinasyon tedavisi
Antidiyabetik ilaçların sayısının artışı tip 2 diyabette hedeflenen HbA1C seviyesini düşürmüştür. Diyabetin uzun dönem komplikasyonlarını azaltmak için sıkı HbA1C kontrolü oldukça önemlidir. Oral antidiyabetiklerin çoğu glisemik kontrolü iyileştirmede etkilidirler ancak açlık hiperglisemisi ve HbA1C ≥ %7 seviyeleri olan tip 2 diyabetli hastalarda glisemiyi normale yakın seviyelere indirmede ender olarak başarılı olurlar. Farklı etki mekanizmalı oral ilaçların kombine kullanımı HbA1C düzeylerini düşürmede ilave etki sağlar. Aynı zamanda daha fazla terapötik güç, daha fazla kolaylık, daha az doz ve yan etki sağlanabilir. Metformin ve yaşam stili değişikliği ile başarısız olunan hastalarda tedavi seçenekleri ya ikinci bir oral ya da enjektabl ajan eklemektir. Eğer HbA1C değeri metformin ve sülfonilüre veya bazal insülin ile başarılamazsa, intensif insülin tedavisi başlanması önerilmektedir. Geleneksel basamaklı yaklaşım basamaklar arasında önemli gecikmelerin yaşanabileceği ve glisemik kontrolün sağlanamadığı sürenin uzayabileceği bir yaklaşımdır. Kısa süreli hiperglisemi dönemleri bile komplikasyon riskini büyük oranda artırır. Basamaklı tedavi yaklaşımdan uzaklaşarak kombinasyon tedavisine erken başlamayı içeren yeni bir tedavi anlayışına geçmek gerekir.
Combination treatment of type 2 diabetes mellitus
The increasing number of antidiabetic drugs decreased HbA1C levels in type 2 diabetes. Strict HbA1C control is very important to decrease the long term complications of diabetes. Although most of the oral antidiabetic drugs are adequate for glycemic control, they are not successful to control patients whose HbA1C levels are more than 7% and who have fasting hyperglycemia. The combined use of the oral drugs that affect in different ways provides additional success to lower HbA1C levels. Moreover, not only are they useful and provide additional power but also they have less side effects with lower doses. In patients whose medical treatment is unsuccessful with metformin and altered life style, adding a second oral or an injectable drug are the other therapeutic alternatives. If the HbA1C levels could not be decreased with metformin, sulfonilurea and basal insulin, intensive insulin therapy must be started. Traditional “step by step” approach may cause worse glycemic control and delay the steps of the therapy. Although hyperglycemia pe¬riods last in short periods it may increase the complications. Traditional “step by step” approach should be avoided and new therapeutic approachs should be preferred including early combined therapy.
J. Exp. Clin. Med., 2012; 29:S39-S43
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- Yayın Aralığı: Yılda 4 Sayı
- Başlangıç: 1980
- Yayıncı: Ondokuz mayıs Üniversitesi Tıp Fakültesi