【病例学习第3期】Diabetes Prevention（糖尿病预防）

From Pharmacy Times(www.pharmacytimes.com)
Thanks to the author Craig I. Coleman, PharmD(Dr. Coleman is an assistant professor of pharmacy practice and director of the pharmacoeconomics and outcomes studies group at the University of Connecticut School of Pharmacy.)

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Diabetes Prevention

During his yearly physical, IR, a 42-year-old Caucasian man, is found to have a blood glucose of 122 mg/dL following an overnight fast. IR is instructed to exercise more (30 min/ day) and lose weight; but despite these attempts at lifestyle modification, he is found to have a fasting glucose of 119 mg/ dL at a 3-month follow-up visit. IR undergoes an oral glucose tolerance test, and his 2-hour postload glucose is discovered to be 212 mg/dL. Currently, IR is taking amlodipine 10 mg once daily for hypertension and atorvastatin 20 mg daily for hyperlipidemia. He has an immediate family history of diabetes (his mother). Are there any pharmacologic treatments that should be considered for IR?


ANSWERS

IR has both impaired fasting glucose (IFG; a fasting blood glucose between 100 and 125 mg/dL) and impaired glucose tolerance (IGT; a 2-hour postload glucose between 140 and 199 mg/dL). Patients like IR, with IFG and/or IGT are at high risk of developing type 2 diabetes mellitus. Based mainly upon the Diabetes Prevention Program Trial, current American Diabetes Association guidelines emphasize the use of lifestyle modification to prevent or delay the progression from IFG and/or IGT to type 2 diabetes. The only pharmacologic treatment recommended by the guidelines is metformin, and only in those at very high risk, defined as having IGT and IFG plus an HbA1C >6%, hypertension, dyslipidemia, and a first-degree relative with diabetes. Trials (including DREAM, ACTNOW, STOP-NIDDM) also suggest that other oral hypoglycemic drug classes, including glitazones and alpha-glucosidase inhibitors, may be efficacious—and in patients with less stringent definitions of high risk. Whereas IR is likely at very high risk for the future development of diabetes, and because he has already failed a trial of lifestyle modification, it seems reasonable to start him on metformin 850 mg once daily with food, titrated to 850 mg twice daily after a month.

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糖尿病预防：

IR 42岁 男性 高加索人，在每年的体 检中，发现在整夜禁食的情况下，血糖值为122 mg/dL。IR，被告知要多锻炼（30分钟/天），并且减肥，但是尽管做了这些生活方式的尝试，IR，在之后三个月随访中发现，他的空腹血糖值为119 mg/ dL，IR接受了糖耐量检查，发现两小时餐后血糖值为212 mg/dL。目前，IR正在服用氨氯地平 10mg/次，一日一次降血压；阿托伐他汀该 20mg/日，降血脂。IR有直接的家族遗传性糖尿病（他的母亲）。请问是否有人可以给予IR药学治疗方面的建议？

答案：

IR，不仅空腹血糖高（IFG,空腹血糖值：100 and 125 mg/dL），而且糖耐量降低（IGT,餐后2小时血糖值：100 and 125 mg/dL）,像IR这样的患者很容易恶化成2型糖尿病人，主要依据糖尿病防治计划试行办法，，现行的美国糖尿病协会指南强调，运用改变生活方式来防止及推迟IFG 和/或 IGT患者恶化成2性糖尿病人，指南中唯一的药物治疗方面的建议就是，对于被确诊IGT 和 IFG 以及HbA1C >6%,高血压、高血脂并且窒息亲属患有糖尿病的高罹患人群，二甲双胍是唯一推荐的药物。试行办法（包括DREAM, ACTNOW, STOP-NIDDM）也建议其他口服降糖药如：格列喹酮以及α-葡萄糖苷酶抑制药对于那些成为糖尿病人相对风险较低的患者同样有效。然而，IR有极高的风险将来恶化为糖尿病，并且他对于改变生活方式已经失败，看来开始给予他二甲双胍850mg/次，一日一次，一个月后，逐步增量到850mg/次，一日二次是和合理的。

糖尿病的预防

IR是一名42岁的白人男子，在他每年的体检中，被发现快速空腹血糖为122毫克/分升。 IR按指示多运动（30分钟/天）和减肥，但尽管经过这些改变生活方式尝试，在3个月的后续随访中他的空腹血糖仍为119毫克/个月分升。IR进行一个口服葡萄糖耐量试验，口服葡萄糖2小时后的血糖为212毫克/分升。目前IR正在接受平均每日氨氯地平10毫克降压和阿托伐他汀20毫克降治疗。他有糖尿病（母亲）直系亲属的家族史。IR是否应考虑药理治疗？
捣一下乱试译一点，您接着译吧，哈！

不是“窒息亲属”应该为“直系亲属”吧！

结果已经

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