2024年美國糖尿病學會針對第2型糖尿病降血糖藥物之標準治療建議

10.6666/ClinMed.202409_94(3).0105

郝立智；陳鏡方；范麒惠；林沅蓉；連小茵；蕭承愷；潘潔慧；梁維哲；陳昆祥；黃偉輔；楊純宜

糖尿病（diabetes mellitus, DM） ； 美國糖尿病學會（American Diabetes Association , ADA） ； 動脈粥樣硬化性心臟血管疾病（atherosclerotic cardiovascular disease, ASCVD） ； 昇糖素類似胜肽-1（Glucagon-like-peptide-1, GLP-1） ； 鈉－葡萄糖協同轉運蛋白2抑制劑（SGLT2i）

臨床醫學月刊

94卷3期（2024 / 09 / 27）

601 - 613

繁體中文

此次更新的治療指引提出了以下建議：1.胰島素治療：建議使用胰島素類似物或吸入型胰島素，以減少低血糖風險；2.昇糖素（glucagon）處方：為使用胰島素注射或高低血糖風險患者開立昇糖素處方；3.治療計劃評估：定期評估糖尿病患者的治療計劃，以確保達成個人化目標；4.早期聯合治療：對成人第2型糖尿病患者進行早期聯合治療，縮短達成個人化治療目標的時間；5.藥物治療個性化：根據個人化的血糖和體重目標調整治療方案，特別是對無心血管和／或腎臟疾病的患者；6.額外降血糖藥物：對未達到血糖目標的患者，考慮使用額外的降血糖藥物；7.體重管理與血糖控制：強化與體重管理相關的治療方法，確保其與血糖管理目標一致；8.降血糖藥物選擇：優先選擇能降低心血管疾病、心臟衰竭和慢性腎臟病風險的藥物；9.心臟衰竭管理：對心臟衰竭患者，推薦使用鈉－葡萄糖協同轉運蛋白2抑制劑（sodium-glucose cotransporter 2 inhibitor, SGLT2i）來管理血糖並預防住院；10.慢性腎病治療：對第2型糖尿病和慢性腎病患者，應考慮在任何階段進行胰島素治療；11.雙重受體促進劑：使用gastric inhibitory polypeptide（GIP）和glucagon-like peptide-1（GLP-1）雙重受體促進劑，作為胰島素之外的額外血糖管理選擇；12.胰島素劑量評估：在增加GLP-1或雙重受體促進劑劑量時，重新評估胰島素劑量；13.治療目標益處：選擇具有體重管理、心臟代謝或腎臟益處的降血糖藥物；14.低血糖風險評估：在開始或加強胰島素治療時，重新評估其他降血糖藥物的需求和劑量；15.腸梗塞諮詢：向患者提供關於腸梗塞的諮詢，不建議對有胃輕癱病史的患者使用雙重受體促進劑；16.管理障礙指導：為可能阻礙糖尿病管理的患者提供照護指導原則。

1. Davies MJ, Aroda VR, Collins BS, et al. Management of hyperglycemia in type 2 diabetes,2022: a consensus report by the American Diabetes Association(ADA) and the European Association for the Study of Diabetes(EASD).Diabetes Care 2022;45:2753-86.
   連結：
2. Fr_ıas JP, Davies MJ, Rosenstock J, et al. SURPASS-2 Investigators. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. N Engl J Med 2021;385:503-15.
   連結：
3. Matthews DR, Pald_anius PM, Proot P, et al. VERIFY study group. Glycaemic durability of an early combination therapy with vildagliptin and metformin versus sequential metformin monotherapy in newly diagnosed type 2 diabetes(VERIFY): a 5-year, multicentre, randomised, double-blind trial. Lancet 2019;394:1519-29.
   連結：
4. Tsapas A, Avgerinos I, Karagiannis T, et al. Comparative effectiveness of glucose-lowering drugs for type 2 diabetes: a systematic review and network meta-analysis. Ann Intern Med 2020;173:278-86.
   連結：
5. Dahl D, Onishi Y, Norwood P, et al. Effect of subcutaneous tirzepatide vs placebo added to titrated insulin glargine on glycemic control in patients with type 2 diabetes: the SURPASS-5 randomized clinical trial. JAMA 2022;327:534-45.
   連結：
6. Herges JR, Neumiller JJ, McCoy RG. Easing the financial burden of diabetes management: a guide for patients and primary care clinicians. Clin Diabetes 2021;39:427-36.
   連結：
7. Nathan DM, Lachin JM, Bebu I, et al. GRADE Study Research Group. Glycemia reduction in type 2 diabetes - microvascular and cardiovascular outcomes. N Engl J Med 2022; 387:1075-88.
   連結：
8. londe L, Merilainen M, Karwe V. TITRATE Study Group. Patient-directed titration for achieving glycaemic goals using a once-daily basal insulin analogue: an assessment of two different fasting plasma glucose targets - the TITRATE study. Diabetes Obes Metab 2009;11:623-31.
   連結：
9. emlitsch T, Engler J, Siebenhofer A, et al. (Ultra-) long-acting insulin analogues versus NPH insulin(human isophane insulin) for adults with type 2 diabetes mellitus. Cochrane Database Syst Rev 2020;11: CD005613.
   連結：
10. efalu WT, Dawes DE, Gavlak G, et al. Insulin Access and Affordability Working Group. Insulin Access and Affordability Working Group: conclusions and recommendations. Diabetes Care 2018;41:1299-311.
    連結：
11. cCall AL. Insulin therapy and hypoglycemia. Endocrinol Metab Clin North Am2012;41:57-87.
    連結：
12. e la Pe~na A, Riddle M, Morrow LA, et al. Pharmacokinetics and pharmacodynamics of high dose human regular U-500 insulin versus human regular U-100 insulin in healthy obese subjects. Diabetes Care 2011;34:2496-501.
    連結：
13. ecker RH, Dahmen R, Bergmann K, et al. New insulin glargine 300 Units · mL-1 provides a more even activity profile and prolonged glycemic control at steady state compared with insulin glargine 100 Units · mL-1. Diabetes Care 2015;38:637-43.
    連結：
14. orsatko S, Deller S, Koehler G, et al. A comparison of the steady-state pharmacokinetic and pharmacodynamic profiles of 100 and 200 U/mL formulations of ultra-long-acting insulin degludec. Clin Drug Investig 2013;33:515-21.
    連結：
15. kturk HK, Snell-Bergeon JK, Rewers A, et al. Improved postprandial glucose with inhaled technosphere insulin compared with insulin aspart in patients with type 1 diabetes on multiple daily injections: the STATstudy. Diabetes Technol Ther 2018;20:639-47.
    連結：
16. oogwerf BJ, Pantalone KM, Basina M, et al. Results of a 24-week trial of technosphere insulin versus insulin aspart in type 2 diabetes. Endocr Pract 2021;27:38-43.
    連結：
17. astellanaM, Cignarelli A, Brescia F, et al. GLP-1 receptor agonist added to insulin versus basal-plus or basal-bolus insulin therapy in type 2 diabetes: a systematic review and meta-analysis. Diabetes Metab Res Rev 2019;35:e3082.
    連結：
18. odbard HW, Visco VE, Andersen H, et al. Treatment intensification with stepwise addition of prandial insulin aspart boluses compared with full basal-bolus therapy(FullSTEP Study): a randomised, treat-to-target clinical trial. Lancet Diabetes Endocrinol 2014;2:30-7.
    連結：
19. American Diabetes Association Professional Practice Committee. 9. Pharmacologic approaches to glycemic treatment: Standards of Care in Diabetes—2024. Diabetes Care 2024;47(Suppl. 1):S158-78.
20. American Diabetes Association. Standards of medical care in diabetes(Position Statement). Diabetes Care 2009;28:S13-31.