ACP臨床ガイドライン委員会：2型糖尿病経口治療 ・・・ 経口治療はメトホルミン第1選択

ACP臨床ガイドライン委員会：2型糖尿病経口治療

Annals of Internal Medicine   February 7, 2012 vol. 156 no. 3 218-231

Oral Pharmacologic Treatment of Type 2 Diabetes Mellitus: A Clinical Practice Guideline From the American College of Physicians 

Amir Qaseem, MD, PhD, MHA; Linda L. Humphrey, MD, MPH;Donna E. Sweet, MD;Melissa Starkey, PhD; and Paul Shekelle, MD, PhD

for the Clinical Guidelines Committee of the American College of Physicians

フリー pdf:http://www.annals.org/content/156/3/218.full.pdf+html 


食事、ライフスタイル変容に治療応答しない患者への第1選択はメトホルミン

メトホルミン単独で高血糖コントロール出来ない場合、二次選択薬へ

Recommendation 1: ACP recommends that clinicians add oral pharmacologic therapy in patients diagnosed with type 2 diabetes when lifestyle modifications, including diet, exercise, and weight loss, have failed to adequately improve hyperglycemia (Grade: strong recommendation; high-quality evidence).

Recommendation 2: ACP recommends that clinicians prescribe monotherapy with metformin for initial pharmacologic therapy to treat most patients with type 2 diabetes (Grade: strong recommendation; high-quality evidence).

Recommendation 3: ACP recommends that clinicians add a second agent to metformin to treat patients with persistent hyperglycemia when lifestyle modifications and monotherapy with metformin fail to control hyperglycemia (Grade: strong recommendation; high-quality evidence).

Clinical Considerations

 • Good management of type 2 diabetes with pharmacologic and nonpharmacologic therapies is important and includes patient education, evaluation, and self-management, for microvascular and macrovascular complications, treatment of hyperglycemia, and minimization of cardiovascular and other long-term risk factors.

• Nonpharmacologic therapy includes dietary modifications, regular exercise, lifestyle modifications, and weight loss.

• Initiation of pharmacologic therapy is an important approach for the effective management of type 2 diabetes when weight loss and/or lifestyle modification fails.

• Metformin monotherapy was more effective in decreasing glycemic levels than other monotherapies, as well as in combination therapy with a second agent. In addition, metformin has the advantage of reducing body weight and improving plasma lipid profiles (in most cases).

• Although combination therapy more effectively reduces hemoglobin A1c levels, it is also associated with more adverse events.

日本では、メトホルミン使う場合、特に、メトグルコの場合、使用制限を受ける。


http://ds-pharma.jp/medical/gakujutsu/diabetes/metformin/mf14/index.html#img1 

使わせないように、使わせないように・・・　がんばってるとしか思えない日本の糖尿病治療の現状