{"id":13177,"date":"2023-12-28T19:07:58","date_gmt":"2023-12-28T11:07:58","guid":{"rendered":"https:\/\/docquity.com\/?post_type=articles&#038;p=13177"},"modified":"2025-02-11T13:38:44","modified_gmt":"2025-02-11T05:38:44","slug":"huong-dan-dieu-tri-ada-2023-chien-luoc-kiem-soat-duong-huyet-bang-thuoc-cho-benh-nhan-dai-thao-duong-type-2","status":"publish","type":"articles","link":"https:\/\/docquity.com\/vi\/articles\/huong-dan-dieu-tri-ada-2023-chien-luoc-kiem-soat-duong-huyet-bang-thuoc-cho-benh-nhan-dai-thao-duong-type-2\/","title":{"rendered":"H\u01af\u1edaNG D\u1eaaN \u0110I\u1ec0U TR\u1eca ADA 2023: CHI\u1ebeN L\u01af\u1ee2C KI\u1ec2M SO\u00c1T \u0110\u01af\u1edcNG HUY\u1ebeT B\u1eb0NG THU\u1ed0C CHO B\u1ec6NH NH\u00c2N \u0110\u00c1I TH\u00c1O \u0110\u01af\u1edcNG TYPE 2"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\"><strong>\u0110I\u1ec2M CH\u00cdNH<\/strong><\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li>L\u1ed1i s\u1ed1ng l\u00e0nh m\u1ea1nh, gi\u00e1o d\u1ee5c b\u1ec7nh nh\u00e2n c\u00e1ch t\u1ef1 ki\u1ec3m so\u00e1t, tr\u00e1nh tr\u00ec tr\u1ec7 trong th\u1ef1c h\u00e0nh v\u00e0 nh\u1eefng y\u1ebfu t\u1ed1 x\u00e3 h\u1ed9i li\u00ean quan \u0111\u1ebfn s\u1ee9c kh\u1ecfe n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc khi \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft cho b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2. Li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c n\u00ean l\u1ea5y b\u1ec7nh nh\u00e2n l\u00e0m trung t\u00e2m, bao g\u1ed3m c\u00e1c b\u1ec7nh l\u00fd m\u1eafc k\u00e8m v\u00e0 m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb.<\/li>\n\n\n\n<li>\u1ede b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 c\u00f3 nguy c\u01a1 cao ho\u1eb7c \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc b\u1ec7nh tim m\u1ea1ch do x\u01a1 v\u1eefa, suy tim v\u00e0\/ho\u1eb7c b\u1ec7nh th\u1eadn m\u1ea1n, ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb n\u00ean bao g\u1ed3m nh\u1eefng t\u00e1c nh\u00e2n l\u00e0m gi\u1ea3m nguy c\u01a1 tim \u2013 th\u1eadn (h\u00ecnh 2 v\u00e0 b\u1ea3ng 1).<\/li>\n\n\n\n<li>Ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c \u0111\u1ee7 hi\u1ec7u l\u1ef1c \u0111\u1ec3 \u0111\u1ea1t v\u00e0 duy tr\u00ec m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc, ch\u1eb3ng h\u1ea1n nh\u01b0 metformin v\u00e0 nh\u1eefng t\u00e1c nh\u00e2n kh\u00e1c, bao g\u1ed3m c\u1ea3 \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p.<\/li>\n\n\n\n<li>Ki\u1ec3m so\u00e1t c\u00e2n n\u1eb7ng l\u00e0 bi\u1ec7n ph\u00e1p c\u00f3 nhi\u1ec1u \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn vi\u1ec7c ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2. N\u00ean c\u00e2n nh\u1eafc ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 vi\u1ec7c gi\u1ea3m c\u00e2n n\u1eb7ng cho b\u1ec7nh nh\u00e2n.<\/li>\n\n\n\n<li>Metformin n\u00ean \u0111\u01b0\u1ee3c ti\u1ebfp t\u1ee5c trong l\u00fac kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng insulin (tr\u1eeb khi b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh ho\u1eb7c b\u1ec7nh nh\u00e2n k\u00e9m dung n\u1ea1p) v\u00ec nh\u1eefng l\u1ee3i \u00edch v\u1ec1 m\u1eb7t \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 chuy\u1ec3n h\u00f3a.<\/li>\n\n\n\n<li>Li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p s\u1edbm n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb \u0111\u1ec3 gi\u1ea3m nguy c\u01a1 th\u1ea5t b\u1ea1i \u0111i\u1ec1u tr\u1ecb.<\/li>\n\n\n\n<li>\u0110i\u1ec1u tr\u1ecb s\u1edbm b\u1eb1ng insulin n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc n\u1ebfu c\u00f3 b\u1eb1ng ch\u1ee9ng d\u1ecb h\u00f3a (s\u1ee5t c\u00e2n), n\u1ebfu c\u00f3 tri\u1ec7u ch\u1ee9ng c\u1ee7a t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft ho\u1eb7c n\u1ed3ng \u0111\u1ed9 A1C r\u1ea5t cao (&gt; 10%) ho\u1eb7c n\u1ed3ng \u0111\u1ed9 \u0111\u01b0\u1eddng huy\u1ebft r\u1ea5t cao (\u2265 300 mg\/dl).<\/li>\n\n\n\n<li>Khi l\u1ef1a ch\u1ecdn c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft, n\u00ean l\u1ea5y b\u1ec7nh nh\u00e2n l\u00e0m trung t\u00e2m. C\u00e2n nh\u1eafc hi\u1ec7u qu\u1ea3 tr\u00ean tim m\u1ea1ch v\u00e0 th\u1eadn, hi\u1ec7u l\u1ef1c, nguy c\u01a1 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft qu\u00e1 m\u1ee9c, t\u00e1c \u0111\u1ed9ng tr\u00ean c\u00e2n n\u1eb7ng, chi ph\u00ed \u0111i\u1ec1u tr\u1ecb v\u00e0 t\u00ecnh tr\u1ea1ng s\u1eb5n c\u00f3 c\u1ee7a thu\u1ed1c, nguy c\u01a1 c\u1ee7a t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i v\u00e0 l\u1ef1a ch\u1ecdn c\u1ee7a b\u1ec7nh nh\u00e2n.<\/li>\n\n\n\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc b\u1ec7nh tim m\u1ea1ch do x\u01a1 v\u1eefa ho\u1eb7c c\u00f3 d\u1ea5u ch\u1ec9 cho th\u1ea5y nguy c\u01a1 tim m\u1ea1ch cao, \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc b\u1ec7nh th\u1eadn ho\u1eb7c suy tim, th\u00ec c\u00e1c thu\u1ed1c thu\u1ed9c nh\u00f3m ch\u1ea5t \u1ee9c ch\u1ebf k\u00eanh \u0111\u1ed3ng v\u1eadn chuy\u1ec3n sodium \u2013 glucose 2 (sodium\u2013glucose cotransporter 2 inhibitor \u2013 SLGT-2i) v\u00e0\/ho\u1eb7c ch\u1ea5t ch\u1ee7 v\u1eadn th\u1ee7 th\u1ec3 glucagon \u2013 like peptide 1 (glucagon-like peptide 1 receptor agonist \u2013 GLP-1 RA) \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u1ee3i \u00edch tr\u00ean tim m\u1ea1ch \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u1ef1a ch\u1ecdn m\u1ed9t c\u00e1ch \u0111\u1ed9c l\u1eadp v\u1edbi A1C v\u00e0 c\u00e1c y\u1ebfu t\u1ed1 c\u00e1 nh\u00e2n kh\u00e1c c\u1ee7a b\u1ec7nh nh\u00e2n \u0111\u1ec3 l\u00e0m gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch, (h\u00ecnh 2, b\u1ea3ng 1).<\/li>\n\n\n\n<li>\u0110\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2, GLP-1 RAn\u00ean \u0111\u01b0\u1ee3c \u01b0u ti\u00ean h\u01a1n insulin n\u1ebfu c\u00f3 th\u1ec3.<\/li>\n\n\n\n<li>N\u1ebfu \u0111\u00e3 s\u1eed d\u1ee5ng insulin, ph\u1ed1i h\u1ee3p \u0111i\u1ec1u tr\u1ecb v\u1edbi GLP-1 RA\u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o \u0111\u1ec3 t\u0103ng hi\u1ec7u l\u1ef1c v\u00e0 t\u00ednh b\u1ec1n v\u1eefng c\u1ee7a hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb, c\u1ee7a l\u1ee3i \u00edch tr\u00ean c\u00e2n n\u1eb7ng v\u00e0 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft.<\/li>\n\n\n\n<li>Kh\u00f4ng n\u00ean tr\u00ec h\u00f5an ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb t\u0103ng c\u01b0\u1eddng cho b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb.<\/li>\n\n\n\n<li>Ch\u1ebf \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c v\u00e0 h\u00e0nh vi d\u00f9ng thu\u1ed1c c\u1ee7a b\u1ec7nh nh\u00e2n n\u00ean \u0111\u01b0\u1ee3c t\u00e1i \u0111\u00e1nh gi\u00e1 th\u01b0\u1eddng xuy\u00ean (m\u1ed7i 3 \u2013 6 th\u00e1ng) v\u00e0 \u0111i\u1ec1u ch\u1ec9nh n\u1ebfu c\u1ea7n thi\u1ebft \u0111\u1ec3 bao g\u1ed3m c\u1ea3 nh\u1eefng y\u1ebfu t\u1ed1 \u0111\u1eb7c tr\u01b0ng c\u1ee7a b\u1ec7nh nh\u00e2n c\u00f3 \u1ea3nh h\u01b0\u1edfng \u0111\u1ebfn s\u1ef1 l\u1ef1a ch\u1ecdn \u0111i\u1ec1u tr\u1ecb (b\u1ea3ng 1, h\u00ecnh 1).<\/li>\n\n\n\n<li>B\u00e1c s\u0129 n\u00ean c\u1ea3nh gi\u00e1c v\u1ec1 t\u00ecnh tr\u1ea1ng overbasalization (t\u1ee9c l\u00e0 ch\u1ec9nh li\u1ec1u basal insulin r\u01a1i v\u00e0o ngo\u00e0i kho\u1ea3ng li\u1ec1u ph\u00f9 h\u1ee3p \u0111\u1ec3 \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111\u01b0\u1eddng huy\u1ebft) v\u1edbi insulin. Nh\u1eefng bi\u1ec3u hi\u1ec7n l\u00e2m s\u00e0ng c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn t\u00ecnh tr\u1ea1ng overbasalization bao g\u1ed3m li\u1ec1u basal insulin &gt; 0.5 \u0111\u01a1n v\u1ecb\/kg\/ng\u00e0y, c\u00f3 s\u1ef1 kh\u00e1c bi\u1ec7t l\u1edbn gi\u1eefa glucose gi\u1edd ng\u1ee7 v\u1edbi glucose bu\u1ed5i s\u00e1ng ho\u1eb7c gi\u1eefa glucose tr\u01b0\u1edbc-sau b\u1eefa \u0103n, h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft qu\u00e1 m\u1ee9c (\u0111\u01b0\u1ee3c ph\u00e1t hi\u1ec7n ho\u1eb7c kh\u00f4ng), v\u00e0 n\u1ed3ng \u0111\u1ed9 \u0111\u01b0\u1eddng huy\u1ebft c\u00f3 nhi\u1ec1u thay \u0111\u1ed5i. T\u00ecnh tr\u1ea1ng overbasalization n\u00ean \u0111\u01b0\u1ee3c t\u00e1i \u0111\u00e1nh gi\u00e1 nhanh ch\u00f3ng \u0111\u1ec3 \u0111\u01b0a ra li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1ee3c c\u00e1 nh\u00e2n h\u00f3a kh\u00e1c.<\/li>\n<\/ul>\n\n\n\n<p><strong>L\u1ef0A CH\u1eccN \u0110I\u1ec0U TR\u1eca THU\u1ed0C H\u1ea0 \u0110\u01af\u1edcNG HUY\u1ebeT<\/strong><\/p>\n\n\n\n<p>Li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, tr\u1eeb khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. Metformin l\u00e0 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n, c\u00f3 chi ph\u00ed th\u1ea5p v\u00e0 c\u00f3 th\u1ec3 l\u00e0m gi\u1ea3m c\u00e1c bi\u1ebfn c\u1ed1 tim m\u1ea1ch v\u00e0 t\u1eed vong. So v\u1edbi sulfonylurea, metofrmin l\u00e0 li\u1ec7u pahps \u0111i\u1ec1u tr\u1ecb \u0111\u1ea7u tay mang l\u1ea1i nhi\u1ec1u l\u1ee3i \u00edch v\u1ec1 A1C, c\u00e2n n\u1eb7ng v\u00e0 b\u1ec7nh tim m\u1ea1ch m\u1eafc k\u00e8m. B\u00e1o c\u1ea3o c\u1ee7a Diabetes Prevention Program Outcomes Study (DPPOS) khuy\u1ebfn ngh\u1ecb ki\u1ec3m tra n\u1ed3ng \u0111\u1ed9 vitamin B12 hi b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng metformin.<\/p>\n\n\n\n<p>Khi A1C \u2265 1.5% \u0111\u1ed1i v\u1edbi \u0111\u01b0\u1eddng huy\u1ebft m\u1ee5c ti\u00eau, nhi\u1ec1u b\u1ec7nh nh\u00e2n c\u1ea7n ph\u1ea3i \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p ho\u1eb7c \u0111\u01b0\u1ee3c \u0111i\u1ec1u tr\u1ecb b\u1eb1ng t\u00e1c nh\u00e2n c\u00f3 kh\u1ea3 n\u0103ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft t\u1ed1t h\u01a1n \u0111\u1ec3 \u0111\u1ea1t v\u00e0 duy tr\u00ec A1C m\u1ee5c ti\u00eau. Insulin l\u00e0 bi\u1ec7n ph\u00e1p \u0111i\u1ec1u tr\u1ecb c\u00f3 hi\u1ec7u qu\u1ea3 h\u01a1n c\u00e1c t\u00e1c nh\u00e2n \u0111i\u1ec1u tr\u1ecb kh\u00e1c. Insulin n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc trong c\u00e1c \u0111i\u1ec1u tr\u1ecb ph\u1ed1i h\u1ee3p \u1ebfu t\u00ecnh tr\u1ea1ng t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft c\u1ee7a b\u1ec7nh nh\u00e2n nghi\u00eam tr\u1ecdng, \u0111\u1eb7c bi\u1ec7t l\u00e0 b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n d\u1ecb h\u00f3a (s\u1ee5t c\u00e2n, t\u0103ng triglycerid m\u00e1u, ketosis). Th\u00f4ng th\u01b0\u1eddng trong th\u1ef1c h\u00e0nh, insulin \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u khi n\u1ed3ng \u0111\u1ed9 \u0111\u01b0\u1eddng huy\u1ebft c\u1ee7a b\u1ec7nh nh\u00e2n \u2265 300 mg\/dL ho\u1eb7c b\u1ec7nh nh\u00e2n c\u00f3 bi\u1ec3u hi\u1ec7n c\u1ee7a t\u0103ng \u0111\u01b0\u1eddng huy\u1ebft.<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-e61e317211d1c18d5561c7d6acaa396c.png\"><br><strong>H\u00ecnh 1. C\u00e1c y\u1ebfu t\u1ed1 c\u00e2n nh\u1eafc khi \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb cho b\u1ec7nh nh\u00e2n<\/strong><\/p>\n\n\n\n<p><strong>\u0110I\u1ec0U TR\u1eca PH\u1ed0I H\u1ee2P<\/strong><\/p>\n\n\n\n<p>Khuy\u1ebfn c\u00e1o truy\u1ec1n th\u1ed1ng \u0111\u00e3 \u0111\u01b0a ra quy tr\u00ecnh b\u1ed5 sung thu\u1ed1c \u0111i\u1ec1u tr\u1ecb theo t\u1eebng b\u01b0\u1edbc \u0111\u1ec3 duy tr\u00ec A1C m\u1ee5c ti\u00eau. L\u1ee3i \u00edch c\u1ee7a vi\u1ec7c b\u1ed5 sung thu\u1ed1c \u0111i\u1ec1u tr\u1ecb theo t\u1eebng b\u01b0\u1edbc l\u00e0 \u0111\u01b0a ra \u0111\u00e1nh gi\u00e1 r\u00f5 r\u00e0ng v\u1ec1 nh\u1eefng t\u00e1c \u0111\u1ed9ng ti\u00eau c\u1ef1c v\u00e0 t\u00edch c\u1ef1c c\u1ee7a thu\u1ed1c m\u1edbi v\u00e0 gi\u1ea3m nguy c\u01a1 c\u1ee7a c\u00e1c t\u00e1c \u0111\u1ed9ng b\u1ea5t l\u1ee3i ti\u1ec1m t\u00e0ng. Tuy nhi\u00ean, c\u0169ng c\u00f3 nh\u1eefng b\u1eb1ng ch\u1ee9ng cho th\u1ea5y n\u00ean kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p \u0111\u1ec3 \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111\u01b0\u1eddng huy\u1ebft nhanh h\u01a1n. Kh\u1edfi \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb b\u1eb1ng li\u1ec7u ph\u00e1p ph\u1ed1i h\u1ee3p n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u00f3 n\u1ed3ng \u0111\u1ed9 A1C cao h\u01a1n A1C m\u1ee5c ti\u00eau 1.5 \u2013 2.0%. Ph\u1ed1i h\u1ee3p thu\u1ed1c c\u00f3 hi\u1ec7u qu\u1ea3 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft cao ho\u1eb7c thu\u1ed1c c\u00f3 t\u00e1c d\u1ee5ng gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch \u2013 th\u1eadn c\u00f3 th\u1ec3 thay th\u1ebf nh\u1eefng bi\u1ec7n ph\u00e1p c\u00f3 kh\u1ea3 n\u0103ng g\u00e2y ra t\u00ecnh tr\u1ea1ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft qu\u00e1 m\u1ee9c. Do v\u1eady, m\u1ee9c \u0111\u1ed9 \u0111i\u1ec1u tr\u1ecb c\u00f3 th\u1ec3 kh\u00f4ng nh\u1ea5t thi\u1ebft ph\u1ea3i \u0111i theo \u0111\u00fang tr\u1eadt t\u1ef1 b\u1ed5 sung thu\u1ed1c \u0111i\u1ec1u tr\u1ecb nh\u01b0ng c\u1ea7n ph\u1ea3i ph\u00f9 h\u1ee3p v\u1edbi b\u1ec7nh nh\u00e2n v\u00e0 tu\u00e2n th\u1ee7 nh\u1eefng nguy\u00ean t\u1eafc l\u1ea5y b\u1ec7nh nh\u00e2n l\u00e0m trung t\u00e2m.<\/p>\n\n\n\n<p>Kh\u00f4ng n\u00ean tr\u00ec ho\u00e3n \u0111i\u1ec1u tr\u1ecb t\u0103ng c\u01b0\u1eddng cho b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111i\u1ec1u tr\u1ecb. Vi\u1ec7c l\u1ef1a ch\u1ecdn thu\u1ed1c b\u1ed5 sung v\u00e0o li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u n\u00ean d\u1ef1a tr\u00ean nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng v\u00e0 s\u1edf th\u00edch c\u1ee7a b\u1ec7nh nh\u00e2n. Nh\u1eefng \u0111\u1eb7c \u0111i\u1ec3m l\u00e2m s\u00e0ng quan tr\u1ecdng c\u1ea7n c\u00e2n nh\u1eafc bao g\u1ed3m b\u1ec7nh nh\u00e2n \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc b\u1ec7nh tim m\u1ea1ch do x\u01a1 v\u1eefa, b\u1ec7nh nh\u00e2n c\u00f3 nguy c\u01a1 cao m\u1eafc b\u1ec7nh tim m\u1ea1ch do x\u01a1 v\u1eefa, suy tim, b\u1ec7nh th\u1eadn m\u1ea1n, b\u00e9o ph\u00ec, b\u1ec7nh gan nhi\u1ec5m m\u1ee1 kh\u00f4ng do r\u01b0\u1ee3u ho\u1eb7c vi\u00eam gan nhi\u1ec5m m\u1ee1 kh\u00f4ng do r\u01b0\u1ee3u v\u00e0 nguy c\u01a1 x\u1ea3y ra c\u00e1c bi\u1ebfn c\u1ed1 c\u00f3 h\u1ea1i ti\u1ec1m t\u00e0ng c\u1ee7a thu\u1ed1c, c\u0169ng nh\u01b0 t\u00ecnh an to\u00e0n, kh\u1ea3 n\u0103ng dung n\u1ea1p thu\u1ed1c v\u00e0 gi\u00e1 c\u1ea3. Nh\u1eefng ho\u1ea1t ch\u1ea5t kh\u00f4ng ph\u1ea3i insulin c\u1ee7a c\u00e1c nh\u00f3m thu\u1ed1c m\u1edbi khi \u0111\u01b0\u1ee3c b\u1ed5 sung v\u00e0o ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb ban \u0111\u1ea7u c\u00f3 th\u1ec3 gi\u1ea3m A1C kho\u1ea3ng 0.7 \u2013 1.0% (h\u00ecnh 2, b\u1ea3ng 1).<\/p>\n\n\n\n<p><strong>B\u1ea3ng 1.<\/strong>&nbsp;T\u00f3m t\u1eaft \u0111\u1eb7c \u0111i\u1ec3m c\u1ee7a c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft<\/p>\n\n\n\n<figure class=\"wp-block-image\"><img decoding=\"async\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-991c3ba106abaaac95711ae11fd39b4d.png\" alt=\"\" \/><\/figure>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-7f114f28314c419505b774cce891914f.png\"><strong>H\u00ecnh 2.&nbsp;<\/strong>S\u1eed d\u1ee5ng thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/p>\n\n\n\n<p>Nhu c\u1ea7u b\u1ed5 sung c\u00e1c thu\u1ed1c \u0111\u01b0\u1eddng ti\u00eam \u0111\u1ec3 t\u0103ng hi\u1ec7u qu\u1ea3 \u0111i\u1ec1u tr\u1ecb kh\u00e1 ph\u1ed5 bi\u1ebfn \u1edf b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2. B\u1ed5 sung basal insulin v\u00e0o ph\u00e1c \u0111\u1ed3 thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft \u0111\u01b0\u1eddng u\u1ed1ng c\u00f3 th\u1ec3 c\u00f3 hi\u1ec7u qu\u1ea3. H\u01a1n n\u1eefa, b\u1eb1ng ch\u1ee9ng hi\u1ec7n c\u00f3 \u1ee7ng h\u1ed9 s\u1eed d\u1ee5ng GLP-1 RA\u1edf b\u1ec7nh nh\u00e2n kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau \u0111\u01b0\u1eddng huy\u1ebft (h\u00ecnh 3). Tuy nhi\u00ean, gi\u00e1 c\u1ea3 v\u00e0 v\u1ea5n \u0111\u1ec1 dung n\u1ea1p l\u00e0 2 y\u1ebfu t\u1ed1 c\u1ea7n \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc th\u1eadn tr\u1ecdng khi \u0111\u01b0a ra quy\u1ebft \u0111\u1ecbnh \u0111i\u1ec1u tr\u1ecb v\u1edbi GLP-1 RA. B\u1ea3ng 2 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn kho\u1ea3ng li\u1ec1u \u0111i\u1ec1u tr\u1ecb c\u0169ng nh\u01b0 d\u1ea1ng b\u00e0o ch\u1ebf v\u00e0 gi\u00e1 c\u1ea3 (t\u1ed5ng s\u1ed1 li\u1ec1u c\u1ea7n thi\u1ebft trong 30 ng\u00e0y v\u1edbi li\u1ec1u t\u1ed1i \u0111a).<\/p>\n\n\n\n<p><strong>B\u1ea3ng 2.<\/strong>&nbsp;Gi\u00e1 c\u1ea3 v\u00e0 kho\u1ea3ng li\u1ec1u c\u1ee7a c\u00e1c thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u1edf Hoa K\u1ef3<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-eb59fc1ab984e8154ecea408dada1b4b.png\"><strong>PH\u1ed0I H\u1ee2P \u0110I\u1ec0U TR\u1eca B\u1eb0NG LI\u1ec6U PH\u00c1P \u0110\u01af\u1edcNG TI\u00caM<\/strong><\/p>\n\n\n\n<p>N\u1ebfu li\u1ec1u basal insulin \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ec9nh \u0111\u1ec3 \u0111\u1ea1t n\u1ed3ng \u0111\u1ed9 glucose huy\u1ebft \u0111\u00f3i m\u1ee5c ti\u00eau (ho\u1eb7c v\u1edbi li\u1ec1u &gt; 0.5 \u0111\u01a1n v\u1ecb\/kg\/ng\u00e0y v\u1edbi ch\u1ec9 \u0111\u1ecbnh ph\u00f9 h\u1ee3p) nh\u01b0ng A1C v\u1eabn kh\u00f4ng \u0111\u1ea1t m\u1ee5c ti\u00eau, th\u00ec c\u00e2n nh\u1eafc ph\u1ed1i h\u1ee3p v\u1edbi nh\u1eefng t\u00e1c nh\u00e2n \u0111i\u1ec1u tr\u1ecb \u0111\u01b0\u1eddng ti\u00eam. Nh\u1eefng li\u1ec7u ph\u00e1p \u0111\u01b0\u1ee3c l\u1ef1a ch\u1ecdn c\u00f3 th\u1ec3 l\u00e0 GLP-1 RAho\u1eb7c tr\u1ecb li\u1ec7u k\u00e9p glucose\u2010dependent insulinotropic polypepide (GIP) v\u00e0 GLP-1 RA. Ph\u1ed1i h\u1ee3p basal insulin v\u1edbi GLP-1 RAc\u00f3 kh\u1ea3 n\u0103ng h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 gi\u1ea3m nguy c\u01a1 t\u0103ng c\u00e2n v\u00e0 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft qu\u00e1 m\u1ee9c so v\u1edbi nh\u1eefng ph\u00e1c \u0111\u1ed3 t\u0103ng c\u01b0\u1eddng v\u1edbi insulin kh\u00e1c (h\u00ecnh 3).<\/p>\n\n\n\n<p><img decoding=\"async\" alt=\"\" src=\"https:\/\/s3-ap-southeast-1.amazonaws.com\/bucket.docquity.com\/journals\/editor\/file-e6214e98d75918fc4a25096ea600cc94.png\"><strong>H\u00ecnh 3.&nbsp;<\/strong>Li\u1ec7u ph\u00e1p \u0111\u01b0\u1eddng ti\u00eam cho b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/p>\n\n\n\n<p>Khi b\u1eaft \u0111\u1ea7u ph\u1ed1i h\u1ee3p \u0111i\u1ec1u tr\u1ecb v\u1edbi c\u00e1c li\u1ec7u ph\u00e1p \u0111\u01b0\u1eddng ti\u00eam, metformin n\u00ean ti\u1ebfp t\u1ee5c \u0111\u01b0\u1ee3c duy tr\u00ec trong ph\u00e1c \u0111\u1ed3, trong khi \u0111\u00f3 sulfonylurea v\u00e0 dipeptidyl peptidase 4 inhibitors (DPP-4i) th\u00ec n\u00ean b\u1ecb r\u00fat ra kh\u1ecfi ph\u00e1c \u0111\u1ed3 v\u00e0 ng\u01b0ng \u0111i\u1ec1u tr\u1ecb. \u0110\u1ed1i v\u1edbi nh\u1eefng b\u1ec7nh nh\u00e2n ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft k\u00e9m t\u1ed1i \u01b0u, \u0111\u1eb7c bi\u1ec7t \u1edf nh\u1eefng b\u1ec7nh nh\u00e2n c\u1ea7n li\u1ec1u l\u1edbn insulin, c\u00e1c li\u1ec7u ph\u00e1p ph\u1ee5 tr\u1ee3 nh\u01b0 thiazolidinedione ho\u1eb7c SGLT-2i c\u00f3 th\u1ec3 gi\u00fap c\u1ea3i thi\u1ec7n vi\u1ec7c ki\u1ec3m so\u00e1t \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 gi\u1ea3m li\u1ec1u insulin c\u1ea7n thi\u1ebft v\u00e0 gi\u1ea3m c\u00e1c ph\u1ea3n \u1ee9ng b\u1ea5t l\u1ee3i. Khi b\u1eaft \u0111\u1ea7u \u0111i\u1ec1u tr\u1ecb v\u1edbi basal insulin, vi\u1ec7c ch\u1ec9nh li\u1ec1u v\u1edbi gi\u1edd \u0103n v\u00e0 ch\u1ec9nh li\u1ec1u basal insulin d\u1ef1a tr\u00ean n\u1ed3ng \u0111\u1ed9 \u0111\u01b0\u1eddng huy\u1ebft l\u00e0 r\u1ea5t quan tr\u1ecdng. Vi\u1ec7c hi\u1ec3u \u0111\u1eb7c t\u00ednh d\u01b0\u1ee3c \u0111\u1ed9ng h\u1ecdc c\u1ee7a d\u1ea1ng b\u00e0o ch\u1ebf c\u1ee7a t\u1eebng c\u00f4ng th\u1ee9c insulin c\u0169ng r\u1ea5t quan tr\u1ecdng. Tuy nhi\u00ean, \u0111\u1ed1i v\u1edbi nh\u00f3m b\u1ec7nh nh\u00e2n m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2 cao tu\u1ed5i, vi\u1ec7c \u0111\u01a1n gi\u1ea3m h\u00f3a ph\u00e1c \u0111\u1ed3 \u0111i\u1ec1u tr\u1ecb v\u1edbi insulin c\u0169ng c\u1ea7n thi\u1ebft.<\/p>\n\n\n\n<p><strong>L\u1edcI K\u1ebeT<\/strong><\/p>\n\n\n\n<p>B\u00e0i vi\u1ebft \u0111\u01b0\u1ee3c l\u01b0\u1ee3c d\u1ecbch t\u1eeb h\u01b0\u1edbng d\u1eabn ki\u1ec3m so\u00e1t \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng c\u1eadp nh\u1eadt n\u0103m 2023 c\u1ee7a Hi\u1ec7p h\u1ed9i \u0110\u1ea1i Th\u00e1o \u0111\u01b0\u1eddng Hoa K\u1ef3. Hy v\u1ecdng b\u00e0i vi\u1ebft c\u00f3 th\u1ec3 h\u1ed7 tr\u1ee3 qu\u00fd \u0111\u1ed3ng nghi\u1ec7p trong vi\u1ec7c c\u1eadp nh\u1eadt v\u00e0 b\u1ed5 sung ki\u1ebfn th\u1ee9c \u0111\u1ec3 ki\u1ec3m so\u00e1t b\u1ec7nh nh\u00e2n \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng ph\u00f9 h\u1ee3p h\u01a1n. \u0110\u1ed9i ng\u0169 Docquity s\u1ebd ti\u1ebfp t\u1ee5c cung c\u1ea5p nh\u1eefng b\u1ea3n t\u00f3m t\u1eaft kh\u00e1c v\u1ec1 qu\u1ea3n l\u00fd b\u1ec7nh m\u1eafc k\u00e8m, l\u1ed1i s\u1ed1ng vv t\u1eeb h\u01b0\u1edbng d\u1eabn \u0111i\u1ec1u tr\u1ecb c\u1ee7a ADA 2023. M\u1eddi qu\u00fd \u0111\u1ed3ng nghi\u1ec7p theo d\u00f5i v\u00e0 \u0111\u00f3n \u0111\u1ecdc.<\/p>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\" \/>\n\n\n\n<p><strong>T\u00c0I LI\u1ec6U THAM KH\u1ea2O<\/strong><\/p>\n\n\n\n<ol class=\"wp-block-list\">\n<li>Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, Dennis Bruemmer, Billy S. Collins, Marisa E. Hilliard, Diana Isaacs, Eric L. Johnson, Scott Kahan, Kamlesh Khunti, Jose Leon, Sarah K. Lyons, Mary Lou Perry, Priya Prahalad, Richard E. Pratley, Jane Jeffrie Seley, Robert C. Stanton, Robert A. Gabbay; on behalf of the American Diabetes Association, 9. Pharmacologic Approaches to Glycemic Treatment: Standards of Care in Diabetes\u20142023. Diabetes Care 1 January 2023; 46 (Supplement_1): S140\u2013S157. https:\/\/doi.org\/10.2337\/dc23-S009<\/li>\n\n\n\n<li>Nuha A. ElSayed, Grazia Aleppo, Vanita R. Aroda, Raveendhara R. Bannuru, Florence M. Brown, Dennis Bruemmer, Billy S. Collins, Kenneth Cusi, Marisa E. Hilliard, Diana Isaacs, Eric L. Johnson, Scott Kahan, Kamlesh Khunti, Jose Leon, Sarah K. Lyons, Mary Lou Perry, Priya Prahalad, Richard E. Pratley, Jane Jeffrie Seley, Robert C. Stanton, Robert A. Gabbay; on behalf of the American Diabetes Association, 4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes\u20142023. Diabetes Care 1 January 2023; 46 (Supplement_1): S49\u2013S67. https:\/\/doi.org\/10.2337\/dc23-S004<\/li>\n<\/ol>\n","protected":false},"excerpt":{"rendered":"<p>\u0110I\u1ec2M CH\u00cdNH L\u1ef0A CH\u1eccN \u0110I\u1ec0U TR\u1eca THU\u1ed0C H\u1ea0 \u0110\u01af\u1edcNG HUY\u1ebeT Li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb b\u1eb1ng thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c kh\u1edfi \u0111\u1ea7u k\u1ec3 t\u1eeb th\u1eddi \u0111i\u1ec3m b\u1ec7nh nh\u00e2n \u0111\u01b0\u1ee3c ch\u1ea9n \u0111o\u00e1n m\u1eafc \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng, tr\u1eeb khi c\u00f3 ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh. Metformin l\u00e0 li\u1ec7u ph\u00e1p \u0111i\u1ec1u tr\u1ecb hi\u1ec7u qu\u1ea3 v\u00e0 an to\u00e0n, c\u00f3 chi ph\u00ed th\u1ea5p v\u00e0 &hellip;<\/p>\n<p class=\"read-more\"> <a class=\"\" href=\"https:\/\/docquity.com\/vi\/articles\/huong-dan-dieu-tri-ada-2023-chien-luoc-kiem-soat-duong-huyet-bang-thuoc-cho-benh-nhan-dai-thao-duong-type-2\/\"> <span class=\"screen-reader-text\">H\u01af\u1edaNG D\u1eaaN \u0110I\u1ec0U TR\u1eca ADA 2023: CHI\u1ebeN L\u01af\u1ee2C KI\u1ec2M SO\u00c1T \u0110\u01af\u1edcNG HUY\u1ebeT B\u1eb0NG THU\u1ed0C CHO B\u1ec6NH NH\u00c2N \u0110\u00c1I TH\u00c1O \u0110\u01af\u1edcNG TYPE 2<\/span> Read More &raquo;<\/a><\/p>\n","protected":false},"author":123,"featured_media":13179,"comment_status":"closed","ping_status":"closed","template":"","meta":{"content-type":"","inline_featured_image":false,"site-sidebar-layout":"default","site-content-layout":"default","ast-global-header-display":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","footnotes":""},"articles_categories":[1370],"articles_tags":[],"articles_topics":[1441],"articles_languages":[1375],"articles_filters":[],"class_list":["post-13177","articles","type-articles","status-publish","has-post-thumbnail","hentry","articles_categories-medical-content-vi","articles_languages-vietnamese-vi"],"_links":{"self":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/13177","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles"}],"about":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/types\/articles"}],"author":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/users\/123"}],"replies":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/comments?post=13177"}],"version-history":[{"count":0,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles\/13177\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media\/13179"}],"wp:attachment":[{"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/media?parent=13177"}],"wp:term":[{"taxonomy":"articles_categories","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_categories?post=13177"},{"taxonomy":"articles_tags","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_tags?post=13177"},{"taxonomy":"articles_topics","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_topics?post=13177"},{"taxonomy":"articles_languages","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_languages?post=13177"},{"taxonomy":"articles_filters","embeddable":true,"href":"https:\/\/docquity.com\/vi\/wp-json\/wp\/v2\/articles_filters?post=13177"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}