鈉-葡萄糖共同轉運蛋白2抑制劑治療第2型糖尿病人：病例報告

Sodium-Glucose Cotransporter 2 Inhibitor on Type 2 Diabetes Mellitus Patient: A Case Report

第2型糖尿病(T2DM)是一種全球、慢性、漸進性且無法治癒的疾病，因其發病率和死亡率不斷增加，造成世界醫療保健系統相當高的社會經濟負擔。過去不少病人在服用雙胍類及磺醯尿素類失效後，最終皆需接受胰島素的注射治療，所幸近年來有關其用藥治療有不少新的突破，可以延緩此時程，其中最新上巿的為與胰島素作用無關的鈉-葡萄糖共同轉運蛋白2抑制劑(SGLT2i)。本文舉一病例為在所有口服降血糖藥物皆試過的失效治療後，最後以克醣錠併用SGLT2i取代原來之二肽基胜肽酶4-抑制劑(DPP4i)，再次治療成功的案例，且其可再減少總口服降血糖藥品項及減少藥費的支出。與胰島素無關的機轉用藥，對某些使用過去口服降血糖藥失效病人，可能可提供另外的選擇，但近來美國食品藥品管理局(FDA)針對SGLT2i部份副作用作警訊，故本文參考近年來的研究文獻及FDA報告，整理成SGLT2i的適應症、副作用、禁忌症及額外的作用等，以提供國內醫療人員的參考。

Type 2 diabetes mellitus (T2DM) is a chronic, progressive and incurable disease associated with ever-increasing morbidity and mortality resulting in considerable socioeconomic burden for healthcare systems worldwide. In the past, many T2DM patients failing oral therapy had to rely on insulin injection eventually. Fortunately, in recent years, there have been several breakthroughs in the development of oral antidiatetic drugs (OADs) that help delay the reliance; the latest one available in the market is the sodium-glucose cotransporter 2 inhibitors (SGLT2i), whose mechanism of action is independent of insulin. The article shows how a case with OADs failure was successfully treated by replacing the original dipeptidyl peptidase-4 inhibitors (DPP4i) with SGLT2i in combination with metformin. The SGLT2i further helped reduce the types of OADs and the overall drug expenses. For patients failing oral therapy, the insulin-independent SGLT2i may be an effective alternative. Recently, however, the U.S. Food and Drug Administration (FDA) has issued warnings about the side effects of the drug. The FDA reports and related studies had accordingly been reviewed and the indications, side effects, contraindications and extra-benefit of SGLT2i listed in a comprehensive manner to provide medical professionals with appropriate reference.