Clinical Practice Guideline 2015: Oral Hypoglycemic Agents for Patients with Type 2 Diabetes

Seung-Hyun Ko

doi:10.4093/jkd.2016.17.2.83

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Ko: Clinical Practice Guideline 2015: Oral Hypoglycemic Agents for Patients with Type 2 Diabetes

Focused Issue

J Korean Diabetes 2016;17(2):83-87.

Published online: 10 January 2016

DOI: https://doi.org/10.4093/jkd.2016.17.2.83

Clinical Practice Guideline 2015: Oral Hypoglycemic Agents for Patients with Type 2 Diabetes

Seung-Hyun Ko

Division of Endocrinology and Metabolism, Department of Internal Medicine, College of of Medicine, The Catholic University of Korea, Seoul, Korea

Corresponding author: Seung-Hyun Ko Division of Endocrinology and Metabolism, Department of Internal Medicine, The Catholic University of Korea, St. Vincent's Hospital, 93 Jungbu-daero, Paldal-gu, Suwon 16247, Korea, E-mail: kosh@catholic.ac.kr

Revised 28 April 2016 Accepted 6 May 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

The revised Clinical Practice Guideline (5th edition) for patients with diabetes was released in November 2015 by the Korean Diabetes Association. Strict glycemic control is emphasized for the prevention and progression of diabetes-related vascular complications. The recommended target goal of HbA1c is less than 6.5%, especially for patients with recently diagnosed type 2 diabetes. To achieve this target goal, various classes of oral hypoglycemic agents and insulin should be initiated promptly, according to the patient's clinical situation. Accurate and up-to-date information about the available oral hypoglycemic agents will help increase glycemic control and diabetes management.

Keywords: Diabetes mellitus type 2, Hypoglycemic agents, Treatment guideline

References

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2. Korean Academy of Medical Sciences. Evidence-based guideline for type 2 diabetes in primary care. Seoul: Korean Academy of Medical Sciences;2014.

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Fig. 1.

Treatment algorithm of newly diagnosed patients with type 2 diabetes. DPP-4, dipeptidylpeptidase-4; SU, sulfonylurea; GLN, meglitinide; TZD, thiazolidinedione; SGLT-2, sodium-glucose cotransporter-2; GLP-1A, glucagon-like peptide-1 receptor agonist; OHA, oral hypoglycemic agents.

Table 1.

Clinical recommendation for antihyperglycemic treatment in type 2 diabetes

I. 초기치료 원칙
1. 당뇨병 진단 초기부터 적극적인 생활습관개선 및 적절한 약물치료가 필요하다.(A)
2. 약제의 작용기전과 효능, 부작용, 비용 및 환자의 특성과 선호도를 고려하여 적절한 단독 또는 병합요법 약제를 선택한다.(E)
II. 약물 병합요법
1. 경구약제 단독요법 시 초 치료로 메트포르민을 우선적으로 고려하나, 환자 상태에 따라 적절한 약제를 선택한다.(A)
2. 단독요법으로 혈당조절 목표 도달에 실패할 경우 작용기전이 다른 약제의 병합요법을 시행한다.(A)
3. 환자에 따라 진단 시점부터 2제 병합요법을 시행한다.(B)
4. 단일약제를 최대용량까지 증량할 수 있으나 혈당조절이나 부작용을 고려하여 조기에 병합요법을 사용한다.(B)
5. 2제 이상의 병합요법 시 서로 다른 약제의 작용기전, 상호작용, 비용, 순응도를 고려하여 선택하는 것이 좋다.(C)
6. 병합요법 실패 시 인슐린치료가 추천되나 타계열 약제의 추가나 변경을 고려할 수 있다.(C)
(A) 권고사항에 대한 명확한 근거가 있는 경우, (B) 권고사항에 대한 신뢰할만한 근거가 있는 경우, (C) 권고사항에 대한 가능한 근거가 있는 경우, (E) 전문가 권고사항.

Table 2.

Characteristics of oral hypoglycemic agents for patients with type 2 diabetes

약제	작용기전과용법	체중증가	저혈당(단독)	A1C 감소(단독)	가격/정	부작용	주의점
Biguanide (metformin)	간 당생성 감소, 말포 인슐린감수성 개선, 소량부터 시작	없음	없음	1.0∼1.5%	54∼112원	소화기장애, 젖산증, 비타민 B12 결핍	중증간, 신장애, 탈수, 심폐 부전시 금기. 요오드조영제 사용 시 중지, eGFR 45 미만 주의, 30 미만 금지
설폰요소제(gliclazide, glipizide, glimepiride, glibenclamide)	베타세포에서 인슐린분비 증가, 식전 복용	있음	있음	1.0∼2.0%	115∼276원	관절통, 관절염,요통, 기관지염	중증간, 신장애, 이차실패
알파글루코시다아제 (acarbose, voglibose)	상부위장관에서 다당류흡수를 억제, 식후고혈당개선, 하루3회 식전복용	없음	없음	0.5∼1.0%	95∼149원	소화장애	중증간, 신장애, 소화흡수 장애를 동반한 만성 장질환, 중증감염
Thiazolidinedione (pioglitazone, lobeglitazone)	근육, 지방의 인슐린 감수성 개선, 간 당생성 감소, 식사 관계 없이 일1회 복용	있음	없음	0.5∼1.4%	620원	체중증가, 혈색소감소, 골절부종, 심부전	절, 중증심부전, 간 및 중증 신장애
Meglitinde (repaglinide, mitiglinide, nateglinide)	인슐린분비 증가, 식후고혈당 개선, 하루 3회 식사직전 복용	있음	있음	0.5∼1.5%	210∼300원	변비, 상기도감염부비동염	염, 중증간, 신장애
DPP-4 억제제(sitagliptin, vildagliptin, linagliptin, saxagliptin, gemigliptin, alogliptin, teneligliptin)	Incretin 분해 억제, 식후글루카곤분비 억제, 식후고혈당 개선, 식사 관계 없이 복용	없음	없음	0.5∼1.0%	740∼910원	비인두염, 상기도감염, 위장장애	신장애, 일부약제는 장기사용 시 심혈관계 안정성 미확보
SGLT-2 억제제(dapagliflozin, ipragliflozin, empagliflozin)	신장에서 당 재흡수를 억제하여 소변으로 당 배출, 식사와 관계 없이 일 1회 복용	감소	없음	0.5∼1.0%	705∼784원	비뇨기계 감염, 탈수, 요로감염	고령, 심부 전 환자, 저혈압, 이뇨제 사용 시 주의, eGFR 60 미만은 권장 되지 않음.

e-GFR, estimated glomerular filtration rate; DPP-4, dipeptidylpeptidase-4; SGLT-2, sodium-glucose cotransporter-2.

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