Review Article

*

* Corresponding author: popy044@yahoo.com

.. 2025 91
HbA1c 7%
HbA1C 6%


1 HbA1c 8% 300
./. 2

1)
2) 3)
- 4) 2
-1 ( )
( )



: , , ,
Thai Pharm Health Sci J 2008;3(1):169-179

(hyperglycemia)
/


(microvascular
complication)

(macrovascular complication)

13th year of Srinakharinwirot Journal of Pharmaceutical Science

1

21
151 .. 2000 221
.. 20102 300 ..
20253
2
912-4

35 2.4
9.6

Thai Pharmaceutical and Health Science Journal, Vol. 3 No. 1, Jan. Apr. 2008

169

 65
2 5
.. 2547
12.3 1 6,7

(American
Diabetic Association; ADA)

1

2

55 - 140 ./.



8
( )

(gluconeogenesis)

diabetic
ketoacidosis 9
diabetic ketoacidosis 1

1
4
1) 1 (Type 1 diabetes mellitus)


170

2) 2 (Type 2 diabetes mellitus)

/

3) (Other specific type of

diabetes mellitus)
b-cell
(trauma)
(pancreatectomy) (neoplasia) (cystic
fibrosis)

4) (Gestational diabetes
mellitus; GDM)

(glucose intolerance)
3


(Impaired fasting glucose)

3 1)
8 (fasting
plasma glucose; FPG)

2) 2
75
(oral glucose tolerance test; OGTT)
3)
glycosylated hemoglobin (HbA1C)

HbA1c

Thai Pharmaceutical and Health Science Journal, Vol. 3 No. 1, Jan. Apr. 2008

HbA1C

1 *

(Impaired glucose tolerance; IGT)

(Impaired fasting glucose; IFG)

Fasting plasma glucose (FPG)

(/)
< 100
100-125
126

Oral glucose tolerance test (OGTT)

(/)
< 140
140-199
200

*
OGTT 2 75
FPG 8

1) (casual
plasma glucose random plasma glucose)
200 / (11.1 / )

2) FPG 126 /
(7.0 /)
3)
(OGTT) 200
/
FPG
100 - 125 ./. impaired fasting glucose
(IFG) 2
OGTT 140-199 ./. impaired
glucose tolerance (IGT)

(pre-diabetes)

HbA1C 6%
90 - 130 ./.
(5.0 - 7.2 /)
180 ./.
(< 10.0 /)1
HbA1C
HbA1C
HbA1C

1
(self monitoring
blood glucose)

(severe acute illness)


1,9

HbA1C 7%
Thai Pharmaceutical and Health Science Journal, Vol. 3 No. 1, Jan. Apr. 2008

171

(glycemic index)


( 130
) 1

20 - 35
/1

2
1 (1
15 12
5 )9

2


8
10


(
50 - 70 )
150 /
(
70 )
3
2 2
(
)

3
8 - 10 3 1

(metformin)
(biguanide)
172

(Insulin sensitizer)
HbA1C 1.5%14
metallic
taste
lactic acidosis 1
100,000 14

2
United Kingdom Prospective
Diabetes (UKPDS)10

(sulfonylurea)
HbA1C
1.5%14




chlorpropamide glibenclamide

gliclazide tolbutamide 11

12
2 12,13
University Group Diabetes
Program
14
(glinides)
(receptor)

HbA1C 1.5%15
(repaglinide) HbA1C
(nateglinide)16


4

3

Thai Pharmaceutical and Health Science Journal, Vol. 3 No. 1, Jan. Apr. 2008

- ( a-glucosidase
inhibitors) aglucosidase


(postprandial hyperglycemia)

HbA1C
0.5-0.8%15
3


The Study to Prevent Non-InsulinDependent Diabetes Mellitus (STOP-NIDDM) study17
-
IGT 714

(P < 0.05)
(thiazolidinediones; TZD)
(glitazones)
peroxisome proliferators-activated receptor g


(Insulin sensitizer)15
TZD HbA1C 0.5 1.4%15


(fluid retention)

15

The PROactive
(Prospective Pioglitazone Clinical Trial in Macrovascular
Events)18 3

(triglyceride) HDL15
(

2)
2 - 4
15


HbA1C 7
2

119 (glargine insulin)
(long acting)

NPH
(rapid acting insulin)
(short
acting insulin)
1 (glucagon-like
peptide 1 agonists: GLP-1) 20
(exenatide) GLP-1 (incretin)
peptides hormone
36 glucagons-1
(L-cell)
GLP-1
(gastric emptying)
GLP-1
(Islets of
Langerhans) 15

2 ..
2005 2

HbA1C 0.5-1%15
HbA1C


2 - 3
6 15
2

12
(amylin agonist)
(pramlintide)
(amylin) b-cell

Thai Pharmaceutical and Health Science Journal, Vol. 3 No. 1, Jan. Apr. 2008

173


(postprandial plasma glucose)

3
HbA1C
0.5 - 0.7%15
1 - 1.5
6 15

1,13

HbA1C 7%

3


( 1)
1
2

HbA1C 7%

(FBS) 250 ./.

11

8 (FBS)
120 ./. HbA1C 7 mg%

10,21

The

174

Finnish Diabetes Prevention Study22

IGT IFG
522

3.5

(P < 0.01) 2
( 27
) (
30 )


5
1
8

3 1
1
13






500 1 - 2 ( / )
5 - 7

850 1,000



850 2
3,000
(long acting) 1

2 - 3

Thai Pharmaceutical and Health Science Journal, Vol. 3 No. 1, Jan. Apr. 2008

 2 1

1:
-

- metformin
2:
-

HbA1C

1-2

- 1

1.5

-
- lactic acidosis
-

-
-
-
- 3
-

- 3
- 3
-
-

- sulfonylureas
- TZDs

- a-glucosidase inhibitors

1.5
0.5 - 1.4

- ,
- lipid profile
-
- lipid profile

0.5 - 0.8

- exenatide

0.5 - 1.0

- glinides

1 - 1.5

- pramlintide

0.5 - 1.0

1.5 - 2.5

(HbA1C 7%)
2
2
HbA1C 7%
1



( 2) HbA1C
8.5%
FBS 250 ./
. (random
glucose level) 300 ./.

13

13 HbA1C
8%

(insulin secretagogue)



(persistent
hyperglycemia)12
(short acting) (rapid acting)

Thai Pharmaceutical and Health Science Journal, Vol. 3 No. 1, Jan. Apr. 2008

175

 2 - 3

HbA1C

1 213
* HbA1C 3 7 6
2

176

Thai Pharmaceutical and Health Science Journal, Vol. 3 No. 1, Jan. Apr. 2008

 2 insulin13
* (premixed insulin)

Thai Pharmaceutical and Health Science Journal, Vol. 3 No. 1, Jan. Apr. 2008

177

Prof. RME Richards

12.

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in diabetes 2007. Diabetes Care 2007;26 (Suppl 1):S441.
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diabetes and the dysmetabolic syndrome in the real
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5. Aekplakorn W, Stolk RP, Neal B, et al. The Prevalence
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.
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( 4 ;
Pancreas). : ,
(). , 2. .
, 2545: .383-388.
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, (). Advance in
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Formulary 38. London: the British Medical

Association and the Royal Pharmaceutical Society
of Great Britain; 1999.
Barclay L. New guidelines for management of
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medical news [online]. 2006. (Accessed on Jan. 10,
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Original Article

Current Principle of Pharmacotherapy in Diabetes Mellitus

Wiraphol Phimarn* and Phayom Sookaneknun
Department of Clinical Pharmacy and Research, Faculty of Pharmacy, Mahasarakham University, Thailand 44150
* Corresponding author: popy044@yahoo.com

ABSTRACT
Diabetes is a chronic disease which is rapidly increasing in the global population. In Asia the approximate increment in
diabetes patients will be 91% in 2025. The goal of the current treatment guideline is to achieve HbA1c < 7% or to control blood
glucose as close to normal (HbA1C < 6%) without hypoglycemia in the individual patient. Blood glucose levels close to normal
reduce the risk of diabetic complications. The current guideline recommends starting the therapy with lifestyle modifications and
appropriate dosage of metformin, with timely addition of other medications, and transition to new regimens as required. If blood
glucose levels do not reach the goal or persistent hyperglycemia is diagnosed then insulin therapy is indicated to achieve and
maintain blood glucose at the goal. The previous therapy for type 2 diabetes included lifestyle modifications, insulin, sulfonylurea
and metformin. At the present, there are many antihyperglycemic agents used for monotherapy or combination therapy. The
antihyperglycemic agents which are available are insulin secretagogues (e.g. sulfonylurea and glinide), insulin sensitizers
(biguanide, thiazolidinedione/glitazone), alpha-glucosidase inhibitors (reducing glucose absorption from the intestines), insulin
and two new categories which have been approved by the USA FDA. The first category is GLP-1 (exenatide injection) which
inhibits glucagon secretion and increase beta cells in the pancreas. The other category is an amylin agonist (pramlintide
injection) which inhibits glucagon synthesis. Choosing specific antihyperglycemic agents depends on their effectiveness in
lowering blood sugar concentrations and reducing long-term complications, as well as their safety, patient tolerance and cost.
There is no evidence showing benefits of one medication over all other medications. Therefore the principle for choosing
appropriate medication therapy depends on its ability to achieve and maintain the glycemic goals and to treat other
complications.
Key words: diabetes, metformin, lifestyle modification, pharmacotherapy
Thai Pharm Health Sci J 2008;3(1):169-179

13th year of Srinakharinwirot Journal of Pharmaceutical Science

Thai Pharmaceutical and Health Science Journal, Vol. 3 No. 1, Jan. Apr. 2008

179