제 2형 당뇨병 환자에서 사상체질에 따른 경구 혈당강하요법의치료 반응성 및 사용 패턴 평가 (The Difference of Efficacy for Oral Hypoglysemic Pharmacotherapy Based on Sasang Constitutional Medicine Among Type II Diabetes Mellitus Patients in Korea)

서지정보

· 발행기관 : 대한약학회
· 수록지 정보 : 약 학 회 지 / 58권 / 1호 / 71 ~ 79페이지
· 저자명 : 김지연, 이명구, 김정태, 임성실

초록

Although Korean patients with type 2 diabetes mellitus (T2DM) are generally treated by western medicine,many of them strongly believe in the traditional oriental Sasang constitutional classification and depend on it for food,health supplements, and oriental medicines decision making. Sasang constitutional classification is a part of traditionalKorean medicine that divides people into four constitutional types (Tae-Yang: TY, Tae-Eum: TE, So-Yang: SY, and So-Eum:SE), which differ in inherited characteristics such as appearance, personality traits, susceptibility to diseases, and drugresponses. It is recommended for T2DM patients to control their blood glucose very well from early stages with drugsand diet. However, many T2DM patients respond differently to their drugs, even though they receive the same medicine. Therefore, the present study investigated whether Sasang constitutional type can explain the therapeutic differencesbetween oral hypoglycemic agents (OHAs) therapy (mono, dual and triple drug therapy). Patients of 618 with T2DM diagnosisand Sasang constitutional type known who received both western and oriental medicine treatment in a hospitalbetween April 2006 and April 2013 retrospectively studied. HbA1c (%) and blood glucose (mg/dl) levels before OHAs therapyand 3 month after were collected for metformin (MET) or sulfonylurea (SU) monotherapy, MET+SU dual therapy,MET+except SU (where was either alpha-glucosidase inhibitor, dipeptidyl peptidase-4 inhibitor, meglitinide or thiazolidinedione)dual therapy, and triple therapy, according to Sasang constitutional type. For statistical analysis, ANOVA wasused and paired t-test by SPSS 19.0 where P values less than 0.05 were considered statistically significant. Pattern wassimilar levels of HbA1c and blood glucose and which was decreased in order of mono, MET+SU dual, MET+except SUdual and triple therapy. In all patients comparison, for the So-yang (SY) constitutional type, either monotherapy was lesseffective; for Te-eum (TE) type, MET+SU dual therapy was less effective while MET+except SU dual therapy was moreeffective and the triple therapy was less effective; and for So-eum (SE) type, the triple therapy was more effective. Forthe management of TE type it is recommended to use drugs except SU when dual therapy is needed, restrict triple therapyand consider dual and insulin therapy; for SY type it is recommended to follow current guidelines; and for SE typeit is advisable to skip dual therapy and start the triple therapy early. Finally, the therapeutic response to OHAs is differentamong Korean T2DM patients with different Sasang constitutional types. Taken together, the choice of effective OHAstherapy for each type is necessary in order to minimize the poor control of blood glucose level, the risk of complications,and the costs from a failure of therapy.

영어초록

Although Korean patients with type 2 diabetes mellitus (T2DM) are generally treated by western medicine,many of them strongly believe in the traditional oriental Sasang constitutional classification and depend on it for food,health supplements, and oriental medicines decision making. Sasang constitutional classification is a part of traditionalKorean medicine that divides people into four constitutional types (Tae-Yang: TY, Tae-Eum: TE, So-Yang: SY, and So-Eum:SE), which differ in inherited characteristics such as appearance, personality traits, susceptibility to diseases, and drugresponses. It is recommended for T2DM patients to control their blood glucose very well from early stages with drugsand diet. However, many T2DM patients respond differently to their drugs, even though they receive the same medicine. Therefore, the present study investigated whether Sasang constitutional type can explain the therapeutic differencesbetween oral hypoglycemic agents (OHAs) therapy (mono, dual and triple drug therapy). Patients of 618 with T2DM diagnosisand Sasang constitutional type known who received both western and oriental medicine treatment in a hospitalbetween April 2006 and April 2013 retrospectively studied. HbA1c (%) and blood glucose (mg/dl) levels before OHAs therapyand 3 month after were collected for metformin (MET) or sulfonylurea (SU) monotherapy, MET+SU dual therapy,MET+except SU (where was either alpha-glucosidase inhibitor, dipeptidyl peptidase-4 inhibitor, meglitinide or thiazolidinedione)dual therapy, and triple therapy, according to Sasang constitutional type. For statistical analysis, ANOVA wasused and paired t-test by SPSS 19.0 where P values less than 0.05 were considered statistically significant. Pattern wassimilar levels of HbA1c and blood glucose and which was decreased in order of mono, MET+SU dual, MET+except SUdual and triple therapy. In all patients comparison, for the So-yang (SY) constitutional type, either monotherapy was lesseffective; for Te-eum (TE) type, MET+SU dual therapy was less effective while MET+except SU dual therapy was moreeffective and the triple therapy was less effective; and for So-eum (SE) type, the triple therapy was more effective. Forthe management of TE type it is recommended to use drugs except SU when dual therapy is needed, restrict triple therapyand consider dual and insulin therapy; for SY type it is recommended to follow current guidelines; and for SE typeit is advisable to skip dual therapy and start the triple therapy early. Finally, the therapeutic response to OHAs is differentamong Korean T2DM patients with different Sasang constitutional types. Taken together, the choice of effective OHAstherapy for each type is necessary in order to minimize the poor control of blood glucose level, the risk of complications,and the costs from a failure of therapy.

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