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糖尿病百寶箱:被遺忘了的饋寶 The Diabetes Treasure Chest: A Forgotten Gift

 




內分泌及糖尿科專科醫生丁昭慧


十多年前,常見的口服糖尿藥物只有三數種,近這十多年可說是治療的豐收年代,現在已有多種新藥物以不同的方式去對付糖尿病,而副作用低,令醫生的糖尿病百寶箱増添新寶貝。然而,在新浪推前浪、新藥大放異彩的時代,有一種藥物竟然用了數十年,依舊是第一線糖尿藥物--它就是甲福明(Metformin)。

 

超過百分之九十五的糖尿病患者屬於二型糖尿病:胰島素荷爾蒙有降血糖的作用,而二型糖尿病主要的病因是身體對胰島素的敏感度不足(即是對胰島素阻抗),引致血糖過高。甲福明就是針對胰島素抗阻,減少肝臟生産糖份,增加肌肉組織吸收過多的血糖,因此它有穩定降血糖之餘,又不會矯枉過正,出現低血糖之副作用。

 

傳統的甲福明配方一天要服用2至3次方能有效控制整天的血糖水平,可是太頻密服藥令糖尿病病人造成不便,或者令他們容易忘記定時服藥。另外,傳統的配方病人較容易在服藥的首三四個星期出現「飽飽滯滯」、增加排便次數等的腸胃不適。所以很多醫生不會一下子便要求病人服用最大的份量,而是慢慢由低份量向上調整,好令病人減少腸胃不適之嚴重程度。

 

有很多病人未必知道原來甲福明有一種長效版本,它降糖作用和傳統的配方相約,而長效版一天只需服用一次,增加病人服藥的依従性,此外它腸胃不適之副作用較低。如果純粹因為腸胃不適而放棄不用甲福明實在可惜,其實可以和醫生商討一下去轉長效,如有一些公營醫療機構沒有提供,病人可以用醫生處方去買。


Endocrinologist Dr Ting Zhao Wei Rose


Over a decade ago, there were only a few types of common oral medications for diabetes. In the past ten years, however, we have witnessed a fruitful era in diabetes treatment, with the emergence of many new drugs that combat diabetes in various ways while having fewer side effects. This has enriched the "diabetes treasure chest" for doctors with new valuable options. Nevertheless, amid this wave of new drugs shining brightly, there is one medication that has been used for decades and remains a first-line treatment for diabetes—Metformin.

More than 95% of diabetes patients have type 2 diabetes, where the primary cause is the body's insufficient sensitivity to insulin (known as insulin resistance), leading to high blood sugar levels. Metformin specifically targets insulin resistance, reducing glucose production in the liver and increasing the absorption of excess glucose by muscle tissues. As a result, it effectively lowers blood sugar levels without causing hypoglycemia as a side effect.

Traditionally, Metformin needed to be taken 2 to 3 times a day to effectively control blood sugar levels throughout the day. However, such frequent dosing can be inconvenient for diabetes patients and might lead them to forget to take their medication on time. Additionally, patients often experience gastrointestinal discomfort, such as feeling full and bloated or increased bowel movements, especially during the first three to four weeks of taking the traditional formulation. Therefore, many doctors do not immediately prescribe the highest dose but gradually increase it from a low dose to reduce the severity of gastrointestinal side effects.

Many patients might not be aware that there is an extended-release version of Metformin. Its glucose-lowering effect is similar to the traditional formulation, but it only needs to be taken once a day, improving patient adherence to the medication. Furthermore, it has fewer gastrointestinal side effects. It is unfortunate to abandon Metformin solely due to gastrointestinal discomfort, as patients can discuss with their doctors about switching to the extended-release version. If some public healthcare institutions do not provide it, patients can purchase it with a prescription from their doctor.

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