medicina47巻12号

2010年11月発行

今月の主題 糖尿病診療Update―いま何が変わりつつあるのか 糖尿病治療薬の使い方

α-グルコシダーゼ阻害薬(α-GI)・グリニド製剤

著者： 大村千恵¹ 綿田裕孝¹

所属機関： ¹順天堂大学医学部内科・代謝内分泌学講座

ページ範囲：P.1979 - P.1982

ポイント

★食後高血糖は，心血管疾患の発症リスクを高め，死亡率を高める．

★α-GI，グリニド製剤はどちらも主に食後高血糖を改善する．

★α-GIの適応は初期の糖尿病患者に限らない．他剤と併用することで食後高血糖を改善する．

★グリニド製剤は食後高血糖が病態の主体の早期2型糖尿病が良い適応である．

参考文献

1）Kubo S, et al：Combination therapy of miglitol and insulin in type 1 diabetes mellitus patients. J Diabetes Invest 1：60-65, 2010

2）Yoshihara T, et al：Therapeutic efficacy of mitiglinide combined with once daily insulin glargine after switching from multiple daily insulin regimen of aspart insulin and glargine in patients with type 2 diabetes mellitus. Endocr J 53：67-72, 2006

3）Kumashiro N, et al：Long-term effect of combination therapy with mitiglinide and once daily insulin glargine in patients who were successfully switched from intensive insulin therapy in short-term study. Endocr J 54：163-166, 2007

4）Uchino H, et al：Impairment of early insulin responses after glucose load, rather than insulin resistance, is responsible for postprandial hyperglycemia seen in obese type 2 diabetes；Assessment using nateglinide, anew insulin secretagogue. Endocr J 47：639-641, 2000

5）Mori Y, et al：Effects of nateglinide on the elevation of postprandial remnant-like particle triglyceride levels in Japanese patients with type 2 diabetes assessment by meal tolerance test. Endocrine 25：203-206, 2004

6）Mita T, et al：Nateglinide reduces carotid intima-media thickening in type 2 diabetes patients under good glycemic control. Arterioscler Thromb Vasc Biol 27：2456-2462, 2007

7）The NAVIGATOR study group：Effect of nategulinide on the incidence of diabetes and cardiovascular events. N Engl J Med 362：1463-1476, 2010