새로이 발표된 개인별 맟춤식 제2형 당뇨병 약물 요법 가이드라인 발표 > 최신 임상 뉴스

새로이 발표된 개인별 맟춤식 제2형 당뇨병 약물 요법 가이드라인 발표

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새로이 발표된 개인별 맟춤식 
 
제2형 당뇨병 약물 요법 가이드라인 발표 
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<img width="544" height="286" style="WIDTH: 542px; HEIGHT: 344px" src="/_dimg/1%20책.bmp">
 
2형 당뇨병은 발병 과정이 다양하고 병태 진행 과정도 다양하다 
 
따라서 미국 당뇨병학회와 유럽 당뇨병 학회는 협동으로 
 
개인 차별화 약물 요법 처방 지침을 새로이 재정 하고 
 
미국 당뇨병 학회 학술지 최신호를 퉁해 발표 하였다
 
<img width="539" height="321" style="WIDTH: 538px; HEIGHT: 424px" src="/_dimg/2%20사라들.bmp">
 
 
 
환자 지향 처방  
 
 환자의 그 때 그때의 병태 상항을 참조 하여 
 
혈당 조절 목표를 나 추거나 높이면서 처방해아한다 
 
부작용을 고려하여 이에 맞는 처방을 처방의가 다양한 처방 모델 중에서 선택한다
 
그리고 혈당 조절 목표와 방법을 환자와 협의하도록 했다
 
이는 지금까지의 가이드라인에서 볼 수 없었던 중요한 변화이다
 
 
 
<img width="588" height="365" style="WIDTH: 586px; HEIGHT: 432px" src="/_dimg/3%20사람ㄴ들들.bmp">
 
 
 
 
나이 따라 혈당 저하 목표를 달리한다
 
 
 나이가 젋고 건강한 당뇨병 환자는 합병증 있는 노인 보다는 
 
혈당 조절 목표를 보다 더 높게 결정해도 능히 달성할 수 있다
 
 
통상 사용되는 당화 헤모구르로빈 수치인 HbA1C 는 
 
지난 2-3월간 의 평균적 혈당 수치를 의미하는 바
 
당뇨병 없는 정상인의 HbA1C 수치는 %-6% 정도이다
 
 
그러나 지; 금까지는 모든 당뇨병자에게 통상적으로
 
HbA1C 수치를 7%이하로 내리도록 목표를 정하도록 권장하였다
 
 

 
 
<img width="558" height="256" style="WIDTH: 556px; HEIGHT: 338px" src="/_dimg/4%20Hb.bmp">
 
그러나 새로이 재정된 지침에서는 
 
합병증 없는 젊은 당뇨병자로서 
 
아직 심한 저 혈당 경험이 없는 자들에게는 
 
HbA1C 수치를 6%-6.5% 정도로 혈당 조절 목표를 강하게 설정하였다
 
그러나 합병증 위험이 높은 65세 이상에게는 
 
 HbA1C 수치 도달 목표를 7.5-8%정도로 권장하도록 하였다
 
그리고 HbA1C 수치가 9%를 넘는 자는 비 인슐린 약물 처방에 인슐린을 추가 하도록 하였다
 
 
 
 

 
 
<img width="507" height="257" style="WIDTH: 506px; HEIGHT: 386px" src="/_dimg/5%20운동d.bmp">
 
식이 요법과 운동 요법 
 
 
식이요법 과 운동 요법은 새로운 지침에서도
 
모든 당뇨 병 자에게 공통적인 필수 권장 사항이다
 
체중감소는 5%-10%를 목표로 하고 1주 2시간 반정도 운동을 권장하고 있다

 
 
<img width="587" height="397" style="WIDTH: 586px; HEIGHT: 500px" src="/_dimg/6%20매트ㅜ포.bmp">
 
 
 
<img width="563" height="427" style="WIDTH: 562px; HEIGHT: 532px" src="/_dimg/6%20amp.bmp"> 
[그림] Metformin은 AMPK라는 효소를 활서오하시켜  약리작용을 발휘
; 
 
 
약물요법의 1차 선택 약은 여전히 Metformin
 
 
Metformin 은 어떤 약보다도 인슐린을 내성 없이 작용하게 하는 약이다
 
당뇨병으로 진단 된 자가 아직도 혈당이 거의 정상에 가까운 자에게는 
 
운동 요법 과 식이요법을 권장해야 한다 
 
 
그러나 3-6월 실시 후에도 혈당 개선이 되지 않으면 Metformin 요법을 시작해야 한다
 
물론 처음 진단 시 혈당이 높은 자는 즉시 Metformin 처방을 시작한다
 
그러나 Metfomin 단독 처방을 3개월 실시했음에도 불구하고
 
혈당이 개선되지 않으면 2차 약을 Metformin 에 추가해 나가야 한다
 
 
 
 
<img width="535" height="249" style="WIDTH: 534px; HEIGHT: 359px" src="/_dimg/7%20저형압.bmp">
[그림] 저혈당 유발 여부는 약물 선택의 중요한 기준중 하나이다 
 
 
2차 약 과 3차 약의 추가
 
 
Metformin 이외의 모든 약은 모두가 각각 다른 장 단점을 지니고 있으므로 
 
환자 개개인의 병태에 따라 선별 해야 한다  
 
새로운 지침에서는 2종 복합 처방 5종류와 
 
3종 복합 처방 5종류와 인슐린 주사 첨가 방법을 새로운 처방 모델로 발표하였다
 

 
 
<img src="/_dimg/8대사ㅡㅇ후.bmp">
[그림] 대사증후군은 개인차 별 혈당 조절 목표 결정에 주요한 요서ㅗ이다
 
 환자와의 협상
 
새로운 지침에서는 처방이 바뀔 때마다 
 
처방의 는 처방 목표 와 목표 달성 방법을 환자와 협의 해야 한다
 
환자가 능히 혈당 목표에 도달 할 수 있는 수준을 목표 혈당으로 정해 주어야 한다
 
 
 
 
 
 
<img width="582" height="257" style="WIDTH: 580px; HEIGHT: 344px" src="/_dimg/9%20합병증하ㅏㅂ뱌ㅕ.bmp">
[그림] 당뇨병 치료 목표는 합병증 예방이다
 
 
 
당뇨병 치료는 합병증 예방이 목적
 
당뇨병 치료는 혈당 강하가 목적이 아니라 합병증을 예방하는 것이다
 
따라서 가능하면 복합 처방을 일직부터 시작 해야 한다 
 
그러나 아직 까지는 복합 처방에 관련한 한 충분한 지식 정보가 충분 하지 않은 상태이다
 
따라서 처방의 는 지침서에 명시된 약물 정보라를 충분히 숙지 해야 할 것이다
 
 
  
 
 
<img width="586" height="305" style="WIDTH: 584px; HEIGHT: 440px" src="/_dimg/10%20RX.bmp">
 
 
새로이 재정된 처방 모델
 
 
당뇨병자는 합병증을 예방하기 위해서는 
 
지질 저하와 혈압 조절이 혈당 내리는 것만큼 중요하다 
 
그러나 아래 표에 나타나 있는 새 지침의 처방 모댈은 혈당 조절만을 목표로 한 것이다’
 
<table style="BORDER-BOTTOM: medium none; BORDER-LEFT: medium none; BORDER-COLLAPSE: collapse; BORDER-TOP: medium none; BORDER-RIGHT: medium none; mso-yfti-tbllook: 1184; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt" border="1" cellspacing="0" cellpadding="0">
<tbody>
<tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes">
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1차 선택 약 (단일제)</td></tr>
<tr>
<td width="206" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 154.25pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffc000; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td>
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Metformi n</td></tr>
<tr>
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약효(HbA1C 저하)</td>
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매우 우수</td></tr>
<tr>
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저 혈당 위험 </td>
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적음</td></tr>
<tr>
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체중 증가</td>
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중화 또는 감소</td></tr>
<tr>
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부작용</td>
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위장 장애, 유산할증</td></tr>
<tr style="mso-yfti-irow: 6; mso-yfti-lastrow: yes">
<td width="707" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 529.9pt; PADDING-RIGHT: 5.4pt; BACKGROUND: lime; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid" colspan="2">
3 개월 투약으로 개선안 되면 2종 복합 처방 실시 </td></tr></tbody></table>
 
<table style="BORDER-BOTTOM: medium none; BORDER-LEFT: medium none; BORDER-COLLAPSE: collapse; BORDER-TOP: medium none; BORDER-RIGHT: medium none; mso-yfti-tbllook: 1184; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt" border="1" cellspacing="0" cellpadding="0">
<tbody>
<tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes">
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ccffff; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="596" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 446.75pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ccffff; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid" colspan="5">
2종 복합 처방</td></tr>
<tr>
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 </td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.1pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Metformi n</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Metformi n</td>
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Metformi n</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Metformi n</td>
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Metformi n</td></tr>
<tr>
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 </td>
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Sulfonylurea</td>
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Glitazone</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
DPP4-Inhibter</td>
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GLP-1 agonist</td>
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Insulin basal</td></tr>
<tr>
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HbA1C저하</td>
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강함</td>
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강함</td>
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중정도</td>
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강함</td>
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가장 강함 </td></tr>
<tr>
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저혈당 위험 </td>
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중등도</td>
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적음</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
적음</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
적음</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.4pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
많음 </td></tr>
<tr>
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffc000; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
체중 증가</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.1pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
증가 </td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
증가</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
중화</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
감소 </td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.4pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
증가</td></tr>
<tr>
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffc000; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
부작용</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.1pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
저혈당</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
부종 심부전
골절</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
드믐</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
위장장애</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.4pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #fbd4b4; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
저혈당</td></tr>
<tr style="mso-yfti-irow: 7; mso-yfti-lastrow: yes">
<td width="707" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 529.9pt; PADDING-RIGHT: 5.4pt; BACKGROUND: lime; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid" colspan="6">
-본 다섯 가지 처방 순서는 약품 개발 순위이며 처방 선호 순위가 아니다 -Sulfonylurea 대신 필요하면 Glinide 계 약물을 대치할 수 있다 
-3개월 투약 후 혈당 개선안 되면 3종 복합 처방으로 전환</td></tr></tbody></table>
 
<table style="BORDER-BOTTOM: medium none; BORDER-LEFT: medium none; BORDER-COLLAPSE: collapse; BORDER-TOP: medium none; BORDER-RIGHT: medium none; mso-yfti-tbllook: 1184; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt" border="1" cellspacing="0" cellpadding="0">
<tbody>
<tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes">
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ccffff; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="596" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 446.75pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ccffff; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid" colspan="5">
3종 복합 처방</td></tr>
<tr>
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffc000; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.1pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Metformi n</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Metformi n</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Metformi n</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Metformi n</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.4pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Metformi n</td></tr>
<tr>
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffc000; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.1pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Sulfonylurea</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Glitazone</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
DPP4-Inhibter</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
GLP-1 agonist</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.4pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Insulin basal</td></tr>
<tr>
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffc000; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.1pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
+Glitazon</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
+Sulfionylurea</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
+Sulfionylurea</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
+Sulfionylurea</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.4pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
+ Gl;itazon</td></tr>
<tr>
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffc000; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.1pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
or DPP4-Inhib</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
or DPP4-Inhib</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
or Glitazon</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
or Glitazon</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.4pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
DPP4-Inhibter</td></tr>
<tr>
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffc000; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.1pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Or GLP- RA</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Or GLP- RA</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.4pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Or GLP- RA</td></tr>
<tr>
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffc000; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.1pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Or Insulin</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Or Insulin</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Or Insulin</td>
<td width="113" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 3cm; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
Or Insulin</td>
<td width="123" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 92.4pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td></tr>
<tr style="mso-yfti-irow: 7; mso-yfti-lastrow: yes">
<td width="707" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 529.9pt; PADDING-RIGHT: 5.4pt; BACKGROUND: lime; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid" colspan="6">
3개월-6개월 후 개선 안되면 인술린주 본격 처방을 추가 
Sulfonylurea 대신 필요료하면 Glinide 계 약물을 대치할 수 있다</td></tr></tbody></table>
 
<table style="BORDER-BOTTOM: medium none; BORDER-LEFT: medium none; BORDER-COLLAPSE: collapse; BORDER-TOP: medium none; BORDER-RIGHT: medium none; mso-yfti-tbllook: 1184; mso-padding-alt: 0cm 5.4pt 0cm 5.4pt" border="1" cellspacing="0" cellpadding="0">
<tbody>
<tr style="mso-yfti-irow: 0; mso-yfti-firstrow: yes">
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ccffff; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="596" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 446.75pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ccffff; BORDER-TOP: black 1pt solid; BORDER-RIGHT: black 1pt solid">
인술인 주사 본격 추가 처방 </td></tr>
<tr style="HEIGHT: 38.55pt; mso-yfti-irow: 1; mso-yfti-lastrow: yes">
<td width="111" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: black 1pt solid; PADDING-LEFT: 5.4pt; WIDTH: 83.15pt; PADDING-RIGHT: 5.4pt; BACKGROUND: #ffc000; HEIGHT: 38.55pt; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
 </td>
<td width="596" style="BORDER-BOTTOM: black 1pt solid; BORDER-LEFT: #ece9d8; PADDING-LEFT: 5.4pt; WIDTH: 446.75pt; PADDING-RIGHT: 5.4pt; BACKGROUND: yellow; HEIGHT: 38.55pt; BORDER-TOP: #ece9d8; BORDER-RIGHT: black 1pt solid">
본 뉴스에서는 상세 설명을 생략합니다</td></tr></tbody></table>
 
 
[근거] 
Diabetes Care Publish Ahead of Print, published online April 19, 2012
ManagementofHyperglycemiainType2
Diabetes: A Patient-Centered Approach
Position Statement of the American Diabetes Association (ADA) and
the European Association for the Study of Diabetes (EASD)
SILVIO E. INZUCCHI, MD  RICHARD M. BERGENSTAL, MD2 JOHN B. BUSE, MD, PHD MICHAELA DIAMANT, MD, PHD4ELE FERRANNINI, MD MICHAEL NAUCK, MD ANNE L. PETERS, MD APOSTOLOS TSAPAS, MD, PHDRICHARD WENDER, MD9
DAVID R. MATTHEWS, MD, DPHILFrom the 1Section of Endocrinology, Yale University School of Medicine and Yale-New Haven Hospital,New Haven, Connecticut; the 2International Diabetes Center at Park Nicollet, Minneapolis, Minnesota; the
3Division of Endocrinology, University of North Carolina School of Medicine, Chapel Hill, North Carolina;the 4Diabetes Center/Department of Internal Medicine, VU University Medical Center, Amsterdam, the Netherlands; the 5Department ofMedicine, University of Pisa School ofMedicine, Pisa, Italy; 6Diabeteszentrum Bad Lauterberg, Bad Lauterberg im Harz, Germany; the 7Division of Endocrinology, Keck School of Medicine,
University of Southern California, Los Angeles, California; the 8Second Medical Department, Aristotle University Thessaloniki, Thessaloniki, Greece; the 9Department of Family and Community Medicine, Jefferson Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania; the 10Oxford Centre for Diabetes, Endocrinology and Metabolism, Churchill Hospital, Headington, Oxford, U.K.; the 11National Institute for
Health Research (NIHR), Oxford Biomedical Research Centre, Oxford, U.K.; and the 12Harris Manchester College, University of Oxford, Oxford, U.K.