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題名 | 糖尿病合併慢性腎病之藥物治療=Drug Therapy in Diabetes Mellitus with Chronic Kidney Disease |
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作者姓名(中文) | 楊璦瑜; 蔡政忠; | 書刊名 | 藥學雜誌 |
卷期 | 32:3=128 2016.09[民105.09] |
頁次 | 頁87-92 |
分類號 | 415.6685 |
關鍵詞 | 糖尿病; 慢性腎臟疾病; 低血糖; Biguanide; Sulfonylureas; DPP-4 inhibitors; |
語文 | 中文(Chinese) |
中文摘要 | 糖尿病是引起慢性腎臟疾病的危險因子之一,約有20-30%的糖尿病人會進展為糖 尿病腎臟病變。根據流行病學的統計資料,在台灣糖尿病、慢性腎病的盛行率逐年上 升。且糖尿病合併慢性腎臟疾病的病人會增加心血管疾病的風險。糖尿病的血糖控制 方法包括生活型態的改善、飲食控制、規律運動、口服藥物以及胰島素。然而糖尿病 藥物治療時會因腎功能不良而增加低血糖的風險,須作藥物使用劑量的調整。 Metformin 是全球公認治療糖尿病的首選藥物,優點是少有低血糖的風險、體重 不會增加。2015年4月衛生福利部公告修訂 metformin 在禁忌症的使用規範為:腎絲 球體過濾率 (eGFR) 介於30-45 mL/min/1.73 m2應減量使用;腎絲球體過濾率 (eGFR) 小於30 mL/min/1.73 m2禁用。Pioglitazone 可用於慢性腎臟疾病,但對於併有心臟衰竭 的病人須謹慎使用。而 sulfonylureas、glinides 及 insulin 類藥物會有低血糖的風險, 從低劑量、緩慢增加劑量使用是重要的,並注意藥物的活性代謝產物會延長低血糖的 時間。DPP-4 inhibitors 不會引起低血糖,多數藥物 (除 linagliptin) 調整劑量後可適用 於慢性腎臟病人。適當的選擇降血糖藥物的合併適當的劑量調整對增進糖尿病合併慢 性腎臟病人的用藥安全而言是重要的。 |
英文摘要 | Diabetes is one of the risk factors for chronic kidney disease (CKD). Approximately 20-30% of people with diabetes will progress to diabetic kidney disease. According to epidemiological statistics, the prevalence of diabetes and chronic kidney disease has been increasing year by year. Patients with diabetes mellitus and chronic kidney disease are in higher risk of cardiovascular disease. Glycemic control in diabetes patients includes improved lifestyle, diet control, regular exercise, oral medications and insulin injections. It will, however, require dosage adjustment regarding the increasing risk of hypoglycemia due to renal insufficiency. Metformin is globally accepted as the first choice for diabetic subjects. In April 2015, the Ministry of Health and Welfare made an announcement that metformin dosage should be reduced once the estimated glomerular filtration rate (eGFR) falls between 30 to 45 mL/min per 1.73m2 and should stop use when it drops below 30 mL/min per 1.73 m2. Pioglitazone can be used in chronic kidney disease, however patients with heart failure should be cautious. The use of sulfonylureas, glinides and insulin can put these patients in danger of hypoglycemia, for this reason, lower doses and slow titration are important. DPP-4 inhibitors do not cause hypoglycemia and most of them (exclusive of linagliptin) require reduction in various stages of renal disease.It is important that appropriate select and dosage adjustment on hypoglycemic agents to improve drug safety in patients with diabetes mellitus and chronic kidney disease. |
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