循環器ジャーナル71巻1号

2023年01月発行

特集 ここが変わった！循環器診療 最新スタンダード Ⅱ．循環器診療に関わる領域

糖尿病

著者： 西田友哉¹ 綿田裕孝¹

所属機関： ¹順天堂大学大学院医学研究科代謝内分泌内科学

ページ範囲：P.129 - P.134

ここが変わった！
●過去のスタンダード
　・細小血管合併症予防のためHbA1c 7.0%未満を目標とする．
　・BMI 22から算出した理想体重に基づき摂取カロリー量を設定する．
　・第一選択薬は明示せず病態に応じた薬剤選択を行う．
●現在のスタンダード
　・高齢者は，患者の特徴や健康状態に基づき個別に血糖管理目標を設定する．
　・食事療法は，個別に設定した目標体重に基づき柔軟な対応を行う．
　・薬物療法は，合併疾患に基づいた薬剤の優先順位を考慮する．

参考文献

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2）厚生労働省．平成26年国民健康・栄養調査報告．2016

3）Japan Diabetes Society（JDS）/Japan Geriatrics Society（JGS）Joint Committee on Improving Care for Elderly Patients with Diabetes. Committee Report : Glycemic targets for elderly patients with diabetes. J Diabetes Investig 2017 ; 8 : 126-8.

4）Look AHEAD Research Group ; Wing RR, Bolin P, Brancati FL, et al. Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes. N Engl J Med 2013 ; 369 : 145-54.

5）日本糖尿病学会（編・著）．糖尿病診療ガイドライン2019，南江堂，2019

6）Tokunaga K, Matsuzawa Y, Kotani K, et al. Ideal body weight estimated from the body mass index with the lowest morbidity. Int J Obesity 1991 ; 15 : 1-5.

7）Tanaka S, Tanaka S, Iimuro S, et al. Body Mass Index and Mortality Among Japanese Patients With Type 2 Diabetes : Pooled Analysis of the Japan Diabetes Complications Study and the Japanese Elderly Diabetes Intervention Trial. J Clin Endocrinol Metab 2014 ; 99 : E2692-6.

8）Emadian A, Andrews RC, England CY, et al. The effect of macronutrients on glycaemic control : a systematic review of dietary randomised controlled trials in overweight and obese adults with type 2 diabetes in which there was no difference in weight loss between treatment groups. Brit J Nutr 2015 ; 114 : 1656-66.

9）Wheeler ML, Dunbar SA, Jaacks LM, et al. Macronutrients, Food Groups, and Eating Patterns in the Management of Diabetes. Diabetes Care 2012 ; 35 : 434-45.

10）de Toro-Martín J, Arsenault BJ, Després JP, et al. Precision Nutrition : A Review of Personalized Nutritional Approaches for the Prevention and Management of Metabolic Syndrome. Nutrients 2017 ; 9 : 913.

11）Evert AB, Dennison M, Gardner CD, et al. Nutrition Therapy for Adults With Diabetes or Prediabetes : A Consensus Report. Diabetes Care 2019 ; 42 : 731-54.

12）Miller ME, Williamson JD, Gerstein HC, et al. Effects of Randomization to Intensive Glucose Control on Adverse Events, Cardiovascular Disease, and Mortality in Older Versus Younger Adults in the ACCORD Trial. Diabetes Care 2014 ; 37 : 634-43.

13）Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes. N Engl J Med 2015 ; 373 : 2117-28.

14）McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med 2019 ; 381 : 1995-2008.

15）Heerspink HJL, Stefánsson BV, Correa-Rotter R, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med 2020 ; 383 : 1436-46.

16）Gerstein HC, Colhoun HM, Dagenais GR, et al. Dulaglutide and cardiovascular outcomes in type 2 diabetes（REWIND） : a double-blind, randomised placebo-controlled trial. Lancet 2019 ; 394 : 121-30.

17）Marso SP, Bain SC, Consoli A, et al. Semaglutide and Cardiovascular Outcomes in Patients with Type 2 Diabetes. N Engl J Med 2016 ; 375 : 1834-44.

18）坊内良太郎，近藤龍也，太田康晴，他．2型糖尿病の薬物療法のアルゴリズム．糖尿病2022 ; 65 : 419-34．