二甲双胍联合DPP-4抑制剂的临床疗效与安全性评价

Efficacy and safety of metformin combined with DPP-4 inhibitor

二肽基肽酶-4(dipeptidyl-peptidase 4,DPP-4)抑制剂通过抑制DPP-4酶而减少胰高血糖素样肽-1(glucagon-likepeptide1,GLP-1)在体内的失活,使内源性GLP-1水平升高,延长其活性,从而发挥降糖作用.二甲双胍目前作为2型糖尿病(type 2 diabetes mellitus,T2DM)患者的一线用药,其作用机制为抑制肝糖原输出,改善胰岛素抵抗.因此,二甲双胍与DPP-4抑制剂联合可发挥机制互补、协同增效的作用.多项研究表明,二甲双胍联合DPP-4抑制剂疗效确切,可减轻体重,低血糖风险低,且多数DPP-4抑制剂的心血管安全性已经得到前瞻性随机对照研究验证.

DPP-4 inhibitors lower blood glucose levels on the basis of increased GLP-1 levels through inhibiting DPP-4 enzyme.Metformin is currently used as a first-line drug for the treatment of type 2 diabetes,the mechanism of which is to inhibit hepatic glycogen output and improve insulin resistance.Therefore,the combination of metformin and DPP-4 inhibitor might play complementary and synergistic roles in the management of type 2 diabetes.A number of clinical studies have shown that DPP-4 inhibitors combined with metformin could effectively lower HbA1c levels,help to lose weight,and with low risk of hypoglycemia,and beyond that,the cardiovascular safety of most DPP-4 inhibitors has been validated in prospective randomized controlled trials.