Currently, among clinical hypoglycemic drugs, hypoglycemic drugs that also have weight loss effects are very popular. In addition to the traditional old drug metformin, which has weight loss effects, some new hypoglycemic drugs have also emerged. Oral drugs such as Dapagliflozin and other SGLT2 Inhibitors, injections such as liraglutide, semaglutide and other GLP-1 receptor agonists, this is because, among type 2 diabetes patients, there are more and more obese people. Obese diabetic patients are more prone to insulin resistance, which affects the pharmacological effects of some hypoglycemic drugs such as insulin and insulin secretagogues. However, most traditional hypoglycemic drugs have hypoglycemic effects by directly or indirectly promoting insulin secretion, or It is achieved by increasing the sensitivity of peripheral tissues to insulin. The physiological effect of insulin is to promote the synthesis of fat and protein. Therefore, these drugs will increase body weight more or less, which is not conducive to the hypoglycemic treatment of obese patients.
In fact, there are a considerable number of emaciated type 2 diabetic patients clinically. Due to their low body weight, these people are not suitable for choosing new hypoglycemic agents with significant weight loss effects So, which hypoglycemic drugs are suitable for this group of people?
For this group of people, they can give preference to hypoglycemic drugs that can increase body weight, such as various traditional insulins Preparations, sulfonylurea hypoglycemic agents such as glimepiride, short-acting insulin secretagogues such as repaglinide, and drugs that have no significant effect on body weight, such as DPP-4 inhibitors represented by linagliptin, etc. New oral hypoglycemic agents.
However, it does not mean that thin diabetic patients can only choose hypoglycemic drugs that increase weight, and cannot use hypoglycemic drugs that reduce weight. For patients, the ultimate goal of hypoglycemic treatment is to prevent the occurrence of diabetic complications, such as coronary heart disease, myocardial infarction, cerebral infarction and other macrovascular diseases, as well as microvascular diseases such as diabetic nephropathy and diabetic peripheral vascular disease, so as to prolong life and improve quality of life Therefore, no matter which type of hypoglycemic drug is used, the ultimate goal is to reach the blood sugar target. It is advocated that weight management should be taken into account on the premise that the blood sugar can reach the target.
Secondly, each class of hypoglycemic drugs has various adverse reactions, and the impact on body weight is only one of the factors. Other factors should be considered, such as the risk of hypoglycemia of various insulin secretagogues and insulin preparations, the risk of fracture and heart failure of insulin sensitizers such as pioglitazone, the genitourinary tract infection caused by dapaglitazone and other drugs, Gastrointestinal reactions of GLP-1 receptor agonists such as liraglutide, etc.
Finally, for diabetic patients with comorbidities, the hypoglycemic treatment should also consider the impact of comorbidities, such as for type 2 diabetic patients with chronic heart failure , Empagliflozin, Dapagliflozin and other SGLT2 inhibitors can improve the prognosis of heart failure in addition to lowering blood sugar, and can reduce the risk of heart failure hospitalization and death. These drugs have also been written into the heart failure treatment guidelines , has heart failure benefits independent of hypoglycemic therapy. Therefore, for such patients, the effect of drugs on weight reduction cannot only be considered, and its effect on body weight is not unlimited. Such patients You should follow the doctor’s advice and use the medicine rationally under the doctor’s guidance.
In short, for emaciated type 2 diabetes, you can give priority to choosing some The types of hypoglycemic drugs affected, but the impact on body weight cannot be used as the only criterion for choosing hypoglycemic drugs, and the underlying diseases of the patient and other adverse reactions of various drugs, such as the impact of hypoglycemia, should also be considered. Reaching the blood sugar standard is the last word. The blood sugar standard itself can also improve the patient’s emaciated state. Secondly, the combined use of hypoglycemic drugs that have the opposite effect on body weight can not only exert a synergistic effect, but also improve the adverse effects of hypoglycemic drugs on body weight. .