循環器ジャーナル67巻4号

2019年10月発行

特集 冠動脈疾患のリスク管理のフロントライン Ⅱ．冠動脈疾患リスクファクターをどう管理する？

血糖はどう下げる？

著者： 西村和之¹ 坂東泰子¹ 室原豊明¹

所属機関： ¹名古屋大学大学院医学系研究科循環器内科学

ページ範囲：P.608 - P.611

Point
・2型糖尿病患者において心血管イベントは患者の生命予後に大きく関わる問題であり，早期からの治療介入を行う必要がある．
・大血管障害の予防という観点からは血糖をどこまで下げるかということよりも血糖をどのように下げるかということのほうが重要である
・糖尿病治療薬の選択としては，低血糖や血糖変動が少なく体重増加を来しにくい薬剤を選択する．

参考文献

1) Gerstein HC, Miller ME, Byington RP, et al:Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med 358:2545-2559, 2008

2) Duckworth W, Abraira C, Moritz T, et al:Glucose control and vascular complications in veterans with type 2 diabetes. N Engl J Med 360:129-139, 2009

3) Patel A, MacMahon S, Chalmers J, et al:Intensive blood glucose control and vascular outcomes in patients with type 2 diabetes. N Engl J Med 358:2560-2572, 2008

4) UK Prospective Diabetes Study（UKPDS）Group:Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes（UKPDS 33）. Lancet 352:837-853, 1998

5) Holman RR, Paul SK, Bethel MA, et al:10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 359:1577-1589, 2008

6) Davies MJ, D'Alessio DA, Fradkin J, et al:Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association（ADA）and the European Association for the Study of Diabetes（EASD）. Diabetologia 61:2461-2498, 2018

7) UK Prospective Diabetes Study（UKPDS）Group:Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes（UKPDS 34）. Lancet 352:854-865, 1998

8) Dormandy JA, Charbonnel B, Eckland DJ, et al:Secondary prevention of macrovascular events in patients with type 2 diabetes in the PROactive Study（PROspective pioglitAzone Clinical Trial In macroVascular Events）:a randomised controlled trial. Lancet 366:1279-1289, 2005

9) Erdmann E, Dormandy JA, Charbonnel B, et al:The effect of pioglitazone on recurrent myocardial infarction in 2, 445 patients with type 2 diabetes and previous myocardial infarction:results from the PROactive（PROactive 05）Study. J Am Coll Cardiol 49:1772-1780, 2007

10) Nissen SE, Nicholls SJ, Wolski K, et al:Comparison of pioglitazone vs glimepiride on progression of coronary atherosclerosis in patients with type 2 diabetes:the PERISCOPE randomized controlled trial. JAMA 299:1561-1573, 2008

11) Tominaga M, Eguchi H, Manaka H, et al:Impaired glucose tolerance is a risk factor for cardiovascular disease, but not impaired fasting glucose. The Funagata Diabetes Study. Diabetes Care 22:920-924, 1999

12) Chiasson JL, Josse RG, Gomis R, 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

13) Hanefeld M, Cagatay M, Petrowitsch T, 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

14) Zinman B, Wanner C, Lachin JM, et al:Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 373:2117-2128, 2015

15) Mahaffey KW, Neal B, Perkovic V, et al:Canagliflozin for Primary and Secondary Prevention of Cardiovascular Events:Results From the CANVAS Program（Canagliflozin Cardiovascular Assessment Study）. Circulation 137:323-334, 2018

16) Wiviott SD, Raz I, Bonaca MP, et al:Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 380:347-357, 2019

17) Marso SP, Daniels GH, Brown-Frandsen K, et al:Liraglutide and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med 375:311-322, 2016

18) Marso SP, Bain SC, Consoli A, et al:Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 375:1834-1844, 2016