Metformin is the first-line first-line and full-course medication for the treatment of type 2 diabetes. It mainly promotes anaerobic glycolysis of sugars, inhibits hepatic gluconeogenesis, reduces glycogen output, and increases muscle, fat and other peripheral tissues. Sensitivity to insulin increases the uptake and utilization of glucose, inhibits the uptake of glucose by intestinal wall cells, and reduces fasting and postprandial hyperglycemia. In addition, metformin also has a weight loss effect, can inhibit cholesterol biosynthesis and storage, reduce triglyceride and total cholesterol levels, improve vascular endothelial cells function, increase blood flow, especially suitable for obesity or overweight In patients with type 2 diabetes, prevent the occurrence and development of diabetic macrovascular complications and reduce the incidence of cardiovascular events. Metformin is also the basic drug in combination medications. It can be used in combination with other oral hypoglycemic agents or insulin to further improve blood sugar, reduce insulin dosage, weight gain, and risk of hypoglycemia.
Metformin ordinary tablets: 0.5g once a day, 2 times a day, or 0.85g, once a day. The dosage can be adjusted according to the condition in the future. Gradually add to 2g a day and take it in divided doses. The maximum recommended dose for adults is 2.55g per day. Medication during meals can reduce gastrointestinal reactions. Enteric-coated tablets: starting dose 0.25g, 2 times a day, taken before meals. Adjust the dosage according to blood sugar, it can be added up to 3 times a day, 0.25g each time, the maximum recommended dosage for adults is 1.8g per day. Sustained-release tablets: at the beginning, once a day, 0.5g each time, take it at dinner, then adjust the dose according to blood sugar. The maximum daily dose does not exceed 2g.
Acarbose is a commonly used oral hypoglycemic agent in clinical practice. It belongs to α-glucosidase inhibitor. Its active center contains nitrogen in the structure and competitively inhibits α-glucose in the intestine Glucosidase can reduce the decomposition of polysaccharides and sucrose to produce glucose, reduce and delay absorption, so it has the effect of reducing postprandial hyperglycemia and plasma insulin concentration. It is used for type 2 diabetes, especially suitable for type 2 diabetes patients with carbohydrate as the main food ingredient, low fasting blood sugar and elevated blood sugar after meal.In addition, acarbose is also suitable for type 1 diabetes , which needs to be combined with insulin. impaired glucose tolerance patients taking acarbose for a long time can reduce the risk of developing type 2 diabetes.
The oral dose of acarbose needs to be individualized. The general maintenance dose is 50-100mg once, 3 times a day, swallowed immediately before a meal or chewed together with the first staple food. Start with a small dose of 25 mg, 3 times a day, and increase the dose to 50 mg after 6-8 weeks, and 100 mg if necessary, 3 times a day. The daily dose should not exceed 300 mg.
Glimepiride is a commonly used oral hypoglycemic agent in clinical practice. It belongs to the sulfonylurea insulin secretion agent. It lowers blood sugar by stimulating the secretion of insulin by pancreatic islet B cells and has extra-pancreatic effects. Can improve insulin resistance, increase the uptake of glucose by peripheral tissues such as fat, muscle, etc. It is used for adult type 2 diabetes. For patients with metformin intolerance or contraindications, glimepiride can be used as the drug of choice, with metformin alone When the blood sugar cannot reach the standard, it can be combined with glimepiride to increase the blood sugar standard rate.
Glimepiride starts with a daily dosage of 1mg, once a day. If the blood sugar cannot be controlled satisfactorily, gradually increase the dose to 2mg, 3mg, 4mg per day every 1-2 weeks, and the maximum recommended dose is 6mg per day. After reaching a satisfactory effect, the dosage can be reduced on a trial basis to use the lowest effective amount to avoid hypoglycemia. It is recommended to take it shortly before or during breakfast. If you do not eat breakfast, take it shortly before or during the first meal. Swallow the tablet whole with an appropriate amount of water. When switching to glimepiride from other oral hypoglycemic drugs, the hypoglycemic strength and metabolic half-life of the original drug are generally considered to avoid the risk of hypoglycemia caused by the accumulation of drugs. When switching from insulin to glimepiride, blood glucose should be closely monitored.
sitagliptin is a highly selective dipeptidyl peptidase-4 (DPP-4) inhibitor, mainly by inhibiting DPP-4 ,Increasing the level of endogenous active glucagon-like peptide-1 (GLP-1) increases the level of incretin, which can stimulate the pancreatic islets to secrete more insulin, thereby improving hyperglycemia. Therefore, while exerting the hypoglycemic effect, it will not cause the side effects of nausea and vomiting due to the high content of GLP-1 , and will not increase the incidence of weight and hypoglycemia. Suitable for type 2 diabetes.
The recommended dose of sitagliptin monotherapy is 100 mg once a day. Sitagliptin can be taken with or without food. For patients with renal impairment ( creatinine clearance is 30-50ml/min), only 1/2 dosage is required. For severe renal impairment (creatinine clearance <>
dapagliflozin is a sodium-glucose cotransporter 2 (SGLT2) inhibitor, sodium-glucose cotransporter (SGLT) is a glucose transporter, there are SGLT1 and SGLT2 The subtypes are distributed in the small intestinal mucosa and renal tubules. Dapagliflozin inhibits the effect of SGLT2, inhibits glucose reabsorption, lowers renal glucose threshold and promotes urinary glucose excretion, thereby reducing the level of glucose in blood circulation. Suitable for type 2 diabetes.
The recommended starting dose of dapagliflozin is 5mg, once a day, in the morning, without food restriction. For those who need to strengthen blood sugar control and tolerate 5mg, it can be increased to 10mg once a day. Patients with renal insufficiency and glomerular filtration rate (eGFR) ≥ 60 do not need to adjust the dose; patients with 30 ≤ eGFR ≤ 60 are not recommended for use, and patients with eGFR <30>.
