透析糖尿病患者におけるミチグリニド長期投与の有用性と安全性の検討  [in Japanese] Long-term efficacy and safety of mitiglinide in diabetic patients on maintenance hemodialysis  [in Japanese]

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Abstract

維持血液透析中の糖尿病患者28名(前投薬なし5名,ほかの糖尿病薬からの変更23名)にミチグリニドを1年以上継続投与し,ミチグリニド長期投与の有効性と安全性を検討した.前治療別のミチグリニドの有効性の検討:前投薬のない群(5例),ナテグリニド(9例),少量のインスリン(2例)およびボグリボース(1例)からの変更では良好なコントロールが得られたが,スルホニル尿素薬からの変更では良好なコントロールが得られにくかった.ミチグリニド長期投与の有効性と安全性の検討:観察終了時点(中央値26か月:範囲15~28か月)でのグリコアルブミン値(GA)≦21%をコントロールGood,21<GA<24%をFair,GA≧24%をPoorとし,各群間で患者背景,ミチグリニド投与量,低血糖の頻度を比較した.コントロールGood群は13名(46.4%),Fair群7名(25.0%),Poor群8名(28.6%)で,GAの推移(投与前→観察終了時点)は,各々20.8±2.6→18.3±1.8%,23.1±2.4→22.8±0.8%,24.3±4.1→27.2±3.5%であった.ミチグリニド平均投与量は,Good群13.6±9.7,Fair群15.7±9.6,Poor群25.5±5.1mg/日とPoor群の投与量がGood群にくらべて有意に多かった(p<0.05).各群間に年齢,糖尿病罹病歴,透析歴,BMIおよび前治療法に有意差はなかった.低血糖は,Good群7⁄13例,Fair群3⁄7例,Poor群4⁄8例に,主に透析後に認められたが,重症の低血糖は認めなかった.以上より,ミチグリニドは,低血糖に注意しながら慎重に投与すれば,透析糖尿病患者にも有用かつ安全に使用できる薬剤である.

To evaluate long-term efficacy and safety, mitiglinide was administered over 12 months in 28 diabetic patients receiving maintenance hemodialysis(HD) (five : no previous medication with antidiabetic drugs (ADs), 23 : switch from other ADs). Mitiglinide improved glycemic control in patients without previous medication and those switching from nateglinide, low-dose insulin and voglibose, but did not improve glycemic control in many of those who had been treated with sulfonylurea derivatives. We categorized all subjects into three groups according to their glycoalbumin (GA) level at the end of the observation periodv (median 26 months, range 15-28 months) ;Good:GA≤21% (n=13), Fair:21<GA<24% (n=7), and Poor:GA≥24% (n=8). The changes in GA level (start to end point) ranged from 20.8±2.6 to 18.3±1.8%, from 23.1±2.4 to 22.8±0.8%, from 24.3±4.1 to 27.2±3.5% in the respective groups. A daily dosage of mitiglinide was significantly larger in the Poor group than the Good group (25.5±5.1 and 13.6±9.7mg/day, respectively;p<0.05). There were no significant differences in age, duration of diabetes and HD, BMI and previous types of treatment among the three groups. Mild hypoglycemia was found mainly after HD in 7 of 13 cases in the Good group, 3 of 7 cases in the Fair group, 4 of 8 cases in the Poor group, but there were no cases showing severe hypoglycemia. These findings indicate that mitiglinide is effectively and can be safely used for diabetic patients on maintenance HD, if careful attention is paid to hypoglycemia.

Journal

  • Nihon Toseki Igakkai Zasshi

    Nihon Toseki Igakkai Zasshi 41(7), 429-435, 2008-07-28

    The Japanese Society for Dialysis Therapy

References:  11

Cited by:  2

Codes

  • NII Article ID (NAID)
    10024364359
  • NII NACSIS-CAT ID (NCID)
    AN10432053
  • Text Lang
    JPN
  • Article Type
    Journal Article
  • ISSN
    13403451
  • NDL Article ID
    9594682
  • NDL Source Classification
    ZS39(科学技術--医学--皮膚科学・泌尿器科学)
  • NDL Call No.
    Z19-1413
  • Data Source
    CJP  CJPref  NDL  J-STAGE 
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