(5) a - glucosidase inhibitor: delaying carbohydrate in the upper intestine absorb and reduce postprandial blood glucose by a - glucosidase inhibitor, elevated blood sugar in the diet structure applicable to carbohydrate based and postprandial patients, c

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(6) the peptide - peptide - 4 (DPP - -) inhibitor of peptide (DPP - 4) inhibits the inactivation of glucagon like peptide - (GLP - 1) in viv

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(6) the peptide - peptide - 4 (DPP - -) inhibitor of peptide (DPP - 4) inhibits the inactivation of glucagon like peptide - (GLP - 1) in vivo by inhibiting DPP-4, thereby increasing the level of GLP - 1 in vivo. GLP - 1 enhances insulin secretion in a glucose concentration dependent manner, suppresses glucagon secretion, and slows gastric emptying, reducing appetite by central appetite suppression. This type of hypoglycemic drugs due to the late listing, the lack of clinical experience, so the patients with a should be reduced as appropriate. DPP - 4 inhibitors reduced HbA1c to other insulin secreting agents. At present in the domestic market of DPP - 4 for Sig Leo Dean, Shah Glenn Dean, inhibitor vildagliptin and Leigh Glenn Dean.

Sig Leo Dean for GFR = 50ml/ (min, 1.73m2) without the need for dose adjustment in patients with CKD; GFR in 30 ~ 50ml/ (min - 1.73m2) is reduced to 50mg, QD; GFR < 30ml/ (min - 1.73m2) when use limited experience, reduction to 25mg, qd. Shah Glenn Dean for GFR = 50ml/ (min, 1.73m2) without the need for dose adjustment in patients with CKD, while GFR was 30 ~ 49ml/ (min - 1.73m2) when the reduction in patients with CKD4 ~ 5 disabled. Vee Glenn Dean for GFR = 50ml/ (min, 1.73m2) CKD patients without dose adjustment when GFR< 50ml/ (min - 1.73m2) disable.

4 treatment of special populations:

(1) children and adolescents with T2DM associated with CKD: lack of data on treatment of hyperglycemia, hypertension, and dyslipidemia in children and adolescents with T2DM CKD. But lifestyle changes (diet, exercise, weight loss) are beneficial to reduce the risk factors, so the initial intervention for high blood sugar should change the way life begins. If the lifestyle intervention can not control blood sugar, hypoglycemic drugs should be considered. Although ADA recommends oral hypoglycemic agents as first-line therapy for children and adolescents with T2DM, only metformin is approved by FDA for children over the age of 10, and its use is similar to that of adults.

(2) elderly patients with T2DM and CKD: there is a variety of complications in elderly patients with T2DM and CKD, especially cardiovascular disease and cognitive impairment, so we should strengthen the management of multiple risk factors. For this kind of patients should pay attention to avoid hypoglycemia in particular, appropriate adjustments to the treatment goals, and depending on the specific circumstances of the patient with oral antidiabetic drugs; should be started in small dose gradually increased dose and observe the patient response and possible adverse reactions.

 

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