餐后血糖增高型2型糖尿病药物干预的研究及临床实施( 三 )

二肽基肽酶-4(DPP-4)抑制剂
DPP-4抑制剂通过抑制DPP－4（负责降解GLP1的酶）的活性来维持体内GLP1水平。其刺激胰岛素依赖性胰岛素分泌，抑制胰高血糖素释放，延缓胃排空，增加饱腹感。目前，磷酸西他列汀是第一个上市的DPP-4抑制剂。DPP-4抑制剂能通过GLP-1刺激胰岛素分泌而降低餐后血糖，这种胰岛素分泌是葡萄糖依赖性的，在血糖回调之后GLP-1本身也降低，因此低血糖风险小。该药不会有服药后体重增加的担心，患者更容易接受[10] 。
二肽酶-4（DPP-4）抑制剂和胰高血糖素样肽（GLP-1）衍生物是近年来研发的较新的控制餐后血糖的药物，但这类药物的有效性和安全性尚待更多临床试验来评价。
其他口服降糖药物
其他口服降糖药物既可降空腹血糖也可降低餐后血糖。二甲双胍主要通过抑制肝糖原的输出降低空腹血糖，但也有降低餐后血糖的作用。噻唑烷二酮类药物为胰岛素增敏剂，可通过改善外周组织对胰岛素的利用降低餐后血糖。磺脲类对餐后血糖的降低作用强于二甲双胍和噻唑烷二酮类药物，因为它可直接刺激胰岛素分泌降低餐后血糖。但是大部分磺脲类药物尤其是老的磺脲类如优降糖对胰岛素第一时相的刺激作用甚微，选择性降低餐后血糖作用较弱[6] 。
参考文献
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