medicina53巻1号

2016年01月発行

特集 糖尿病治療薬Update—適正使用に向けて 経口血糖降下薬の特性と注意点

αグルコシダーゼ阻害薬

著者： 成田琢磨¹

所属機関： ¹秋田大学大学院医学系研究科内分泌・代謝・老年内科学

ページ範囲：P.34 - P.37

ポイント
●αグルコシダーゼ阻害薬は小腸粘膜で二糖類分解酵素を阻害し，糖吸収を遅延させる．また，食後血糖上昇を抑制し，インスリン分泌を抑制する．
●腹部手術後などイレウスが懸念される症例や，肝硬変など重度の肝障害のある症例では，慎重に投与を検討する．
●GLP-1分泌を増幅し，GIP分泌を抑制する．
●大血管障害抑制や2型糖尿病発症予防にもエビデンスがある．

参考文献

1）Otsuka A, et al：Temporary hyperglycaemia provokes monocyte adhesion to endothelial cells in rat thoracic aorta. Diabetologia 48：2667-2674, 2005

2）Chiasson JL, et al：Acarbose for prevention of type 2 diabetes mellitus；The STOP-NIDDM randomised trial. Lancet 359：2072-2077, 2002

3）Kawamori R, et al：Voglibose for prevention of type 2 diabetes mellitus；A randomised, double-blind trial in Japanese individuals with impaired glucose tolerance. Lancet 373：1607-1614, 2009

4）Chiasson JL, et al：Acarbose treatment and the risk of cardiovascular disease and hypertension in patients with impaired glucose tolerance；The STOP-NIDDM trial. JAMA 290：486-494, 2003

5）Hanefeld M, et al：Acarbose reduces the risk for myocardial infarction in type 2 diabetic patients；Meta-analysis of seven long-term studies. Eur Heart J 25：10-16, 2004

6）Narita T, et al：Miglitol induces prolonged and enhanced glucagon-like peptide-1 and reduced gastric inhibitory polypeptide responses after ingestion of a mixed meal in Japanese Type 2 diabetic patients. Diabet Med 26：187-188, 2009

7）Esposito E, et al：Post-meal glucose peaks at home associate with carotid intima-media thickness in type 2 diabetes. J Clin Endocrinol Metab 93：1345-1350, 2008

8）Yamasaki Y, et al：alpha-Glucosidase inhibitor reduces the progression of carotid intima-media thickness. Diabetes Res Clin Pract 67：204-210, 2005

9）成田琢磨：αグルコシダーゼ阻害薬とインクレチン．Prog Med 28：1893-1897, 2008

10）Miyawaki K, et al：Inhibition of gastric inhibitory polypeptide signaling prevents obesity. Nat Med 8：738-742, 2002

11）Narita T, et al：Comparisons of the effects of 12-week administration of miglitol and voglibose on the responses of plasma incretins after a mixed meal in Japanese type 2 diabetic patients. Diabetes Obes Metab 14：283-287, 2012

12）成田琢磨：最新外来インスリン療法．Q28 STEP-AKITA Study（秋田）とは．糖尿病レクチャー1：127-135, 2010

13）Mikada A, et al：Effects of miglitol, sitagliptin, and initial combination therapy with both on plasma incretins' responses to a mixed meal and visceral fat in over-weight Japanese patients with type 2 diabetes. “The MASTER randomized, controlled trial”. Diabetes Res Clin Pract 106：538-547, 2014