GLP- 1 accelerator, SGLT2 inhibitor and DPP-4 inhibitor have been proved to be very helpful to diabetes by international large-scale research, but the action mechanisms of these three drugs are different, and the effects and side effects brought to diabetic patients are not the same. Patients can make choices according to their physical condition after full discussion with doctors.
How to choose second-line drugs for diabetes? In the past, people thought that diabetic patients should be worried about retinal and renal diseases. In fact, they should be more worried about large blood vessels, because for every two diabetic patients, 1 person died of cardiovascular diseases. The appearance of "three highs" is the main cause of cardiovascular diseases, and the three highs come from obesity and inactivity.
When obesity occurs, fat cells will reduce the sensitivity of insulin, thus reducing appetite and food intake. But if you keep eating, insulin will continue to secrete, and pancreatic overwork will lead to insulin resistance and eventually become diabetes. Therefore, when choosing drugs, we should consider what kind of "weight loss" effect we want.
GLP- 1 accelerator
Wu Zaozhong, secretary-general of Taiwan Province Blood Lipid Health Teaching Association, said that gastrin (GLP- 1) in human body has three functions. One is that after food enters the intestine, it will remind the body that you are full and reduce your appetite. Then it will slow down gastrointestinal peristalsis and reduce hunger. The most important thing is that it can directly protect the heart, because it can inhibit the release of calcium ions, avoid hurting the heart and play a preventive role.
For diabetic patients, cardiovascular disease is the most dangerous disease. GLP- 1 accelerator can achieve two effects of "losing weight and protecting the heart" without much side effects. Because the practice of suppressing appetite is different from that of diet pills to suppress the appetite of the central nervous system, GLP- 1 uses the mechanism of endocrine itself to tell the body that "you don't need to eat so much", as long as you follow the principle of "eat after you are hungry", you can lose weight quickly.
At present, the only side effect observed is gallstones caused by slow gastrointestinal peristalsis, but it is still within the controllable range, and the injection type is inconvenient. Wu Zaozhong said that when the body is used to not eating too much, blood sugar, blood lipids and blood pressure will naturally drop to normal values, and the weight will return to normal, so that there is a chance to stop taking drugs, which is good news for patients.
SGLT-2 inhibitor
SGLT2 inhibitors are also common diabetes drugs, and there are oral drugs at present. The Lancet published an integrated analysis in 20 18 1 1. SGLT2 inhibitors can reduce the risk of hospitalization due to heart failure, reduce cardiovascular adverse events such as myocardial infarction, and even reduce the risk of kidney disease by 45%, but if
Xu Huiheng said that when the kidney makes urine, it will reabsorb the substances in the water and then excrete them. This drug inhibits the "recovery" of glucose by renal tubules, which is equivalent to forcibly expelling the sugar eaten from the body, and the weight will naturally drop. But the disadvantage is that pushing sugar out is easy to cause urinary tract inflammation, so you still have to control your sugar intake.
DPP-4 inhibitor
The mechanism of DPP-4 inhibitor is also related to incretin, but unlike GLP- 1 promoter, DPP-4 is the hormone responsible for the metabolism of GLP- 1 in vivo, so that GLP- 1 will not stay in the body for too long and achieve the balance of the body; Only when overeating leads to obesity can DPP-4 inhibitors be used to block the effect of DPP-4, thus suppressing appetite and controlling blood sugar for a long time.
However, Wu Zaozhong said that DPP-4 inhibitor can only increase the concentration of incretin by 2-4 times, while GLP- 1 promoter can increase it by 8- 10 times, and the inhibition time can be longer. In addition, for people with poor renal function, the dosage of DPP-4 inhibitor needs to be adjusted. Although the side effects are not high, only the effect of lowering blood sugar is known at present.
At present, some doctors will advise patients to choose compound oral drugs, that is, the combination of DPP-4 inhibitor and SGLT-2 inhibitor, which has been included in medical insurance this year and can be used as a compromise drug.