{"id":26921,"date":"2023-05-04T16:50:30","date_gmt":"2023-05-04T09:50:30","guid":{"rendered":"http:\/\/noithathoaphat.in\/ctv\/?p=26921"},"modified":"2023-05-04T16:51:05","modified_gmt":"2023-05-04T09:51:05","slug":"metformin-khong-con-la-thuoc-dau-tay-mac-dinh-cho-moi-benh-nhan-dtd-type-2","status":"publish","type":"post","link":"http:\/\/noithathoaphat.in\/ctv\/index.php\/2023\/05\/04\/metformin-khong-con-la-thuoc-dau-tay-mac-dinh-cho-moi-benh-nhan-dtd-type-2\/","title":{"rendered":"Metformin-kh\u00f4ng c\u00f2n l\u00e0 thu\u1ed1c \u0111\u1ea7u tay m\u1eb7c \u0111\u1ecbnh cho m\u1ecdi b\u1ec7nh nh\u00e2n \u0110T\u0110 Type 2"},"content":{"rendered":"<p><strong>Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, metformin \u0111\u00e3 tr\u1edf th\u00e0nh m\u1ed9t lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2. V\u1edbi kh\u1ea3 n\u0103ng gi\u1ea3m \u0111\u01b0\u1eddng huy\u1ebft hi\u1ec7u qu\u1ea3 v\u00e0 ti\u00eau hao \u00edt nguy\u00ean li\u1ec7u n\u0103ng l\u01b0\u1ee3ng so v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c, metformin \u0111\u00e3 tr\u1edf th\u00e0nh l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u trong \u0111i\u1ec1u tr\u1ecb b\u1ec7nh n\u00e0y. Nh\u01b0ng g\u1ea7n \u0111\u00e2y nh\u1ea5t, theo \u0110\u1ed3ng thu\u1eadn \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng t\u00fdp 2 c\u1ee7a Hi\u1ec7p h\u1ed9i \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u00c2u &#8211; M\u1ef9 (EASD\/ADA) 2022, th\u00ec Metformin kh\u00f4ng c\u00f2n khuy\u1ebfn ngh\u1ecb l\u00e0 thu\u1ed1c \u0111\u1ea7u tay m\u1eb7c \u0111\u1ecbnh cho m\u1ecdi b\u1ec7nh nh\u00e2n <a href=\"https:\/\/www.vinmec.com\/vi\/tin-tuc\/thong-tin-suc-khoe\/benh-tieu-duong-type-2-nguyen-nhan-bien-chung-nguy-hiem-doi-tuong-de-mac-nhat\/\">\u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2<\/a>.\u00a0<\/strong><\/p>\n<p>&nbsp;<\/p>\n<h2><strong>Metformin l\u00e0 thu\u1ed1c g\u00ec? T\u00e1c d\u1ee5ng nh\u01b0 th\u1ebf n\u00e0o tr\u00ean BN \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2?<\/strong><\/h2>\n<p><span style=\"font-weight: 400;\"><a href=\"https:\/\/www.vinmec.com\/vi\/thong-tin-duoc\/su-dung-thuoc-toan\/metformin-thuoc-dieu-tri-benh-tieu-duong-loai-2\/\">Metformin<\/a> (glucophage) l\u00e0 d\u1eabn xu\u1ea5t c\u1ee7a biguanid, thu\u1ed9c nh\u00f3m thu\u1ed1c l\u00e0m t\u0103ng nh\u1ea1y c\u1ea3m v\u1edbi insulin t\u1ebf b\u00e0o. <\/span><span style=\"font-weight: 400;\">Metformin kh\u00f4ng \u0111i\u1ec1u tr\u1ecb nguy\u00ean nh\u00e2n c\u01a1 b\u1ea3n c\u1ee7a b\u1ec7nh ti\u1ec3u \u0111\u01b0\u1eddng. Thu\u1ed1c ch\u1ec9 \u0111i\u1ec1u tr\u1ecb c\u00e1c tri\u1ec7u ch\u1ee9ng c\u1ee7a b\u1ec7nh b\u1eb1ng c\u00e1ch gi\u1ea3m l\u01b0\u1ee3ng \u0111\u01b0\u1eddng trong m\u00e1u qua c\u01a1 ch\u1ebf:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gi\u1ea3m s\u1ea3n xu\u1ea5t glucose \u1edf gan, \u1ee9c ch\u1ebf s\u1ef1 t\u00e2n t\u1ea1o glucose.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gi\u1ea3m \u0111\u1ec1 kh\u00e1ng v\u1edbi insulin.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">T\u0103ng s\u1eed d\u1ee5ng glucose c\u1ee7a m\u00f4 ngo\u1ea1i bi\u00ean (c\u01a1, m\u1ee1).<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gi\u1ea3m triglycerid, cholesterol to\u00e0n ph\u1ea7n, t\u0103ng nh\u1eb9 HDL-c.<\/span><\/li>\n<\/ul>\n<figure id=\"attachment_26958\" aria-describedby=\"caption-attachment-26958\" style=\"width: 1200px\" class=\"wp-caption aligncenter\"><img decoding=\"async\" loading=\"lazy\" class=\"size-full wp-image-26958\" src=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/dai-thao-duong-2-1646582207512704586790.jpeg\" alt=\"Metformin- thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0110T\u0110 type 2\" width=\"1200\" height=\"800\" srcset=\"http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/dai-thao-duong-2-1646582207512704586790.jpeg 1200w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/dai-thao-duong-2-1646582207512704586790-300x200.jpeg 300w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/dai-thao-duong-2-1646582207512704586790-1024x683.jpeg 1024w, http:\/\/noithathoaphat.in\/ctv\/wp-content\/uploads\/2023\/04\/dai-thao-duong-2-1646582207512704586790-768x512.jpeg 768w\" sizes=\"(max-width: 1200px) 100vw, 1200px\" \/><figcaption id=\"caption-attachment-26958\" class=\"wp-caption-text\">Metformin- thu\u1ed1c \u0111i\u1ec1u tr\u1ecb \u0110T\u0110 type 2<\/figcaption><\/figure>\n<h2><strong>T\u00e1c d\u1ee5ng kh\u00f4ng mong mu\u1ed1n c\u1ee7a metformin<\/strong><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">R\u1ed1i lo\u1ea1n ti\u00eau h\u00f3a: ti\u00eau ch\u1ea3y, bu\u1ed3n n\u00f4n<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Ch\u00e1n \u0103n: mi\u1ec7ng c\u00f3 v\u1ecb kim lo\u1ea1i<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Nhi\u1ec5m acid lactic \u00edt g\u1eb7p, nh\u01b0ng c\u1ea7n ch\u00fa \u00fd \u1edf b\u1ec7nh nh\u00e2n suy gan, suy th\u1eadn, nghi\u1ec7n r\u01b0\u1ee3u, thi\u1ebfu oxy m\u00f4 ( suy tim, suy h\u00f4 h\u1ea5p)<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">S\u1eed d\u1ee5ng k\u00e9o d\u00e0i g\u00e2y thi\u1ebfu vitamin B12.\u00a0<\/span><\/li>\n<\/ul>\n<h2><strong>\u01afu \u0111i\u1ec3m c\u1ee7a Metformin h\u01a1n c\u00e1c thu\u1ed1c kh\u00e1c ?<\/strong><\/h2>\n<ul>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Metformin c\u00f3 hi\u1ec7u l\u1ef1c cao, nguy c\u01a1 h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft h\u1ea7u nh\u01b0 kh\u00f4ng c\u00f3.<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">C\u00f3 th\u1ec3 c\u00f3 l\u1ee3i \u0111\u1ed1i v\u1edbi b\u1ec7nh nh\u00e2n c\u00f3 b\u1ec7nh tim m\u1ea1ch do x\u01a1 v\u1eefa<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Gi\u00e1 th\u00e0nh th\u1ea5p<\/span><\/li>\n<li style=\"font-weight: 400;\" aria-level=\"1\"><span style=\"font-weight: 400;\">Kh\u00f4ng l\u00e0m ti\u1ebfn tri\u1ec3n b\u1ec7nh th\u1eadn do \u0110T\u0110, tuy nhi\u00ean c\u1ea7n c\u00e2n nh\u1eafc li\u1ec1u khi eGFR &lt; 30mL\/ph\u00fat\/1,73m<\/span><span style=\"font-weight: 400;\">2<\/span><span style=\"font-weight: 400;\">.<\/span><\/li>\n<\/ul>\n<h2><strong>Theo \u0110\u1ed3ng thu\u1eadn \u0111i\u1ec1u tr\u1ecb \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng t\u00fdp 2 c\u1ee7a Hi\u1ec7p h\u1ed9i \u0110\u00e1i th\u00e1o \u0111\u01b0\u1eddng \u00c2u &#8211; M\u1ef9 (EASD\/ADA) 2022<\/strong><\/h2>\n<p><span style=\"font-weight: 400;\">Metformin t\u1eeb tr\u01b0\u1edbc \u0111\u1ebfn nay v\u1eabn lu\u00f4n \u0111\u01b0\u1ee3c khuy\u1ebfn c\u00e1o l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay trong <\/span><span style=\"font-weight: 400;\">\u0110T\u0110 type 2 do hi\u1ec7u l\u1ef1c gi\u1ea3m HbA1c cao, nguy c\u01a1 g\u00e2y h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft t\u1ed1i thi\u1ec3u khi <\/span><span style=\"font-weight: 400;\">s\u1eed d\u1ee5ng \u0111\u01a1n tr\u1ecb, kh\u00f4ng \u1ea3nh h\u01b0\u1edfng t\u1edbi c\u00e2n n\u1eb7ng, h\u1ed3 s\u01a1 an to\u00e0n t\u1ed1t v\u00e0 gi\u00e1 c\u1ea3 th\u1ea5p.<\/span><\/p>\n<p><span style=\"font-weight: 400;\">Tuy v\u1eady, c\u00e1c chuy\u00ean gia cho r\u1eb1ng c\u00e1c c\u00e1ch ti\u1ebfp c\u1eadn \u0111i\u1ec1u tr\u1ecb kh\u00e1c c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p <\/span><span style=\"font-weight: 400;\">h\u01a1n cho m\u1ed9t s\u1ed1 tr\u01b0\u1eddng h\u1ee3p c\u1ee5 th\u1ec3:<\/span><\/p>\n<ol>\n<li><span style=\"font-weight: 400;\"> L\u1ee3i \u00edch tr\u00ean tim m\u1ea1ch v\u00e0 th\u1eadn c\u1ee7a GLP-1 RA v\u00e0 SGLT2i \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh l\u00e0 <\/span>kh\u00f4ng ph\u1ee5 thu\u1ed9c metformin. Do \u0111\u00f3 c\u00e1c nh\u00f3m thu\u1ed1c n\u00e0y n\u00ean \u0111\u01b0\u1ee3c c\u00e2n nh\u1eafc tr\u00ean BN hi\u1ec7n m\u1eafc ho\u1eb7c c\u00f3 nguy c\u01a1 cao m\u1eafc b\u1ec7nh tim m\u1ea1ch, suy tim ho\u1eb7c b\u1ec7nh th\u1eadn m\u1ea1n t\u00ednh b\u1ea5t k\u1ec3 c\u00f3 s\u1eed d\u1ee5ng metformin hay kh\u00f4ng. Ph\u1ed1i h\u1ee3p \u0111i\u1ec1u tr\u1ecb t\u1eeb s\u1edbm c\u00f3 th\u1ec3 gi\u00fap k\u00e9o d\u00e0i th\u1eddi gian tr\u01b0\u1edbc khi th\u1ea5t b\u1ea1i v\u1edbi tr\u1ecb li\u1ec7u.<\/li>\n<li><span style=\"font-weight: 400;\">Metformin kh\u00f4ng khuy\u1ebfn c\u00e1o d\u00f9ng tr\u00ean eGFR &lt;30 ml\/ph\u00fat\/1,73m2 v\u00e0 c\u1ea7n gi\u1ea3m li\u1ec1u khi eGFR &lt;45ml\/ph\u00fat\/1,73m2<\/span><\/li>\n<li><span style=\"font-weight: 400;\">Metformin c\u00f3 th\u1ec3 g\u00e2y gi\u1ea3m vitamin B12, tr\u1ea7m tr\u1ecdng th\u00eam tri\u1ec7u ch\u1ee9ng b\u1ec7nh th\u1ea7n <\/span><span style=\"font-weight: 400;\">kinh ngo\u1ea1i bi\u00ean. C\u1ea7n theo d\u00f5i \u0111\u1ecbnh k\u1ef3 v\u00e0 b\u1ed5 sung vitamin B12 n\u1ebfu n\u1ed3ng \u0111\u1ed9 thi\u1ebfu <\/span><span style=\"font-weight: 400;\">h\u1ee5t, \u0111\u1eb7c bi\u1ec7t \u1edf \u0111\u1ed1i t\u01b0\u1ee3ng thi\u1ebfu m\u00e1u ho\u1eb7c m\u1eafc b\u1ec7nh th\u1ea7n kinh ngo\u1ea1i bi\u00ean.<\/span><\/li>\n<\/ol>\n<p><span style=\"font-weight: 400;\">Do v\u1eady, \u0111\u1ed3ng thu\u1eadn n\u00e0y khuy\u1ebfn ngh\u1ecb vi\u1ec7c l\u1ef1a ch\u1ecdn thu\u1ed1c n\u00ean \u0111\u01b0\u1ee3c d\u1ef1a tr\u00ean vi\u1ec7c b\u1ec7nh nh\u00e2n <\/span><span style=\"font-weight: 400;\">c\u00f3 nhu c\u1ea7u m\u1ea1nh c\u1ea7n gi\u1ea3m c\u00e1c nguy c\u01a1 tim m\u1ea1ch v\u00e0\/ho\u1eb7c th\u1eadn ho\u1eb7c gi\u1ea3m c\u00e2n.\u00a0<\/span><\/p>\n<h2><strong>T\u00f3m t\u1eaft m\u1ed9t s\u1ed1 \u0111i\u1ec3m \u0111\u00e1ng ch\u00fa \u00fd c\u1ee7a \u0110\u1ed3ng thu\u1eadn EASD\/ADA 2022<\/strong><\/h2>\n<ul>\n<li>Ph\u1ea3i l\u01b0u t\u00e2m \u0111\u1ebfn c\u00e1c y\u1ebfu t\u1ed1 x\u00e3 h\u1ed9i quy\u1ebft \u0111\u1ecbnh \u0111\u1ebfn s\u1ee9c kh\u1ecfe, h\u1ec7 th\u1ed1ng ch\u0103m s\u00f3c s\u1ee9c kh\u1ecfe, ch\u0103m s\u00f3c to\u00e0n di\u1ec7n, l\u1ea5y ng\u01b0\u1eddi b\u1ec7nh l\u00e0m trung t\u00e2m, ch\u1ea5t l\u01b0\u1ee3ng ch\u0103m s\u00f3c v\u00e0 qu\u1ea3n l\u00fd c\u00e2n n\u1eb7ng &#8220;nh\u01b0 m\u1ed9t \u0111i\u1ec1u c\u1ea7n thi\u1ebft th\u00e0nh ph\u1ea7n c\u1ee7a ch\u0103m s\u00f3c to\u00e0n di\u1ec7n\u201d .<\/li>\n<li>C\u00e1c y\u1ebfu t\u1ed1 x\u00e3 h\u1ed9i bao g\u1ed3m t\u00ecnh tr\u1ea1ng kinh t\u1ebf x\u00e3 h\u1ed9i, \u0111i\u1ec1u ki\u1ec7n s\u1ed1ng v\u00e0 l\u00e0m vi\u1ec7c, c\u00e1c l\u0129nh v\u1ef1c \u0111a y\u1ebfu t\u1ed1 (ch\u1eb3ng h\u1ea1n nh\u01b0 nh\u00e0 \u1edf v\u00e0 gi\u00e1o d\u1ee5c), b\u1ed1i c\u1ea3nh v\u0103n h\u00f3a x\u00e3 h\u1ed9i v\u00e0 b\u1ed1i c\u1ea3nh ch\u00ednh tr\u1ecb x\u00e3 h\u1ed9i, ch\u1eb3ng h\u1ea1n nh\u01b0 h\u1ec7 t\u01b0 t\u01b0\u1edfng x\u00e3 h\u1ed9i v\u00e0 c\u00e1c ch\u00ednh s\u00e1ch c\u00f3 th\u1ec3 d\u1eabn \u0111\u1ebfn s\u1ef1 kh\u00e1c bi\u1ec7t v\u1ec1 ch\u0103m s\u00f3c.<\/li>\n<li>Ch\u0103m s\u00f3c to\u00e0n di\u1ec7n bao g\u1ed3m b\u1ea3o v\u1ec7 tim m\u1ea1ch, qu\u1ea3n l\u00fd y\u1ebfu t\u1ed1 nguy c\u01a1 tim m\u1ea1ch, ki\u1ec3m so\u00e1t c\u00e2n n\u1eb7ng v\u00e0 \u0111\u01b0\u1eddng huy\u1ebft, coi t\u1ea5t c\u1ea3 c\u00e1c y\u1ebfu t\u1ed1 n\u00e0y \u0111\u1ec1u quan tr\u1ecdng nh\u01b0 nhau.<\/li>\n<li>L\u1ea7n \u0111\u1ea7u ti\u00ean c\u00f3 \u0111\u1ec1 c\u1eadp \u0111\u1ebfn c\u00e1c bi\u1ebfn ch\u1ee9ng v\u1ec1 gan \u1edf ng\u01b0\u1eddi b\u1ec7nh \u0110T\u0110.<\/li>\n<li>Nh\u1eafc l\u1ea1i t\u1ea7m quan tr\u1ecdng c\u1ee7a t\u0103ng c\u01b0\u1eddng t\u1eadp luy\u1ec7n th\u1ec3 ch\u1ea5t su\u1ed1t c\u1ea3 ng\u00e0y v\u00e0 \u0111\u00eam, bao g\u1ed3m h\u1ea1n ch\u1ebf ng\u1ed3i l\u00e2u, t\u0103ng s\u1ed1 b\u01b0\u1edbc \u0111i v\u00e0 th\u00eam c\u00e1c b\u00e0i t\u1eadp \u0111\u1ed1i kh\u00e1ng ngo\u00e0i t\u1eadp th\u1ec3 d\u1ee5c th\u00f4ng th\u01b0\u1eddng.<\/li>\n<li>M\u1ed9t y\u1ebfu t\u1ed1 m\u1edbi \u0111\u01b0\u1ee3c nh\u1eafc \u0111\u1ebfn l\u00e0 gi\u1ea5c ng\u1ee7 &#8211; c\u1ea3 ch\u1ea5t l\u01b0\u1ee3ng v\u00e0 s\u1ed1 l\u01b0\u1ee3ng \u2013 c\u1ed1 g\u1eafng c\u00f3 \u0111\u01b0\u1ee3c gi\u1ea5c ng\u1ee7 t\u1ef1 nhi\u00ean .<\/li>\n<li>Kh\u00f4ng c\u00f2n khuy\u1ebfn ngh\u1ecb metformin l\u00e0 thu\u1ed1c \u0111\u1ea7u tay m\u1eb7c \u0111\u1ecbnh cho m\u1ecdi BN \u0110T\u0110 type 2, th\u1eeba nh\u1eadn r\u1eb1ng c\u00e1c lo\u1ea1i thu\u1ed1c kh\u00e1c c\u00f3 th\u1ec3 ph\u00f9 h\u1ee3p h\u01a1n khi BN c\u00f3 nhu c\u1ea7u m\u1ea1nh c\u1ea7n gi\u1ea3m nguy c\u01a1 tim m\u1ea1ch v\u00e0\/ho\u1eb7c th\u1eadn ho\u1eb7c gi\u1ea3m c\u00e2n .<\/li>\n<li>V\u1edbi nh\u1eefng ng\u01b0\u1eddi tr\u1ebb tu\u1ed5i, nh\u1eefng ng\u01b0\u1eddi c\u00f3 ti\u1ebfn tri\u1ec3n nhanh c\u1ee7a b\u1ec7nh \u0110T\u0110 type 2 v\u00e0 nguy c\u01a1 tim m\u1ea1ch r\u1ea5t cao, c\u00f3 th\u1ec3 c\u00e2n nh\u1eafc \u0111i\u1ec1u tr\u1ecb t\u00edch c\u1ef1c b\u1eb1ng ph\u1ed1i h\u1ee3p thu\u1ed1c s\u1edbm nh\u01b0 trong th\u1eed nghi\u1ec7m VERIFY.<\/li>\n<li>Ng\u01b0\u1ee3c l\u1ea1i, c\u0169ng c\u1ea7n ph\u1ea3i xem x\u00e9t t\u00ecnh tr\u1ea1ng \u1ed1m y\u1ebfu \u1edf ng\u01b0\u1eddi l\u1edbn tu\u1ed5i v\u00e0 kh\u1ea3 n\u0103ng g\u00e2y ra c\u00e1c t\u00e1c d\u1ee5ng ph\u1ee5, khi k\u00ea \u0111\u01a1n \u1edf nh\u00f3m d\u00e2n s\u1ed1 n\u00e0y.<\/li>\n<li>H\u01b0\u1edbng d\u1eabn c\u0169ng cho bi\u1ebft nh\u1eefng l\u1ed7 h\u1ed5ng b\u1eb1ng ch\u1ee9ng, bao g\u1ed3m c\u00e1c nghi\u00ean c\u1ee9u so s\u00e1nh v\u1ec1 c\u00e1c ph\u01b0\u01a1ng ph\u00e1p gi\u1ea3m c\u00e2n, t\u1ea7m so\u00e1t v\u00e0 ph\u00f2ng ng\u1eeba b\u1ec7nh \u0110T\u0110 trong d\u00e2n s\u1ed1 hi\u1ec7n nay.<\/li>\n<li>D\u00f9 cho ng\u00e0y c\u00e0ng c\u00f3 nhi\u1ec1u b\u1eb1ng ch\u1ee9ng \u1ee7ng h\u1ed9 v\u1ecb tr\u00ed c\u1ee7a SGLT2i v\u00e0 GLP-1 RA trong \u0111i\u1ec1u tr\u1ecb \u0110T\u0110 type 2 d\u1ef1a tr\u00ean hi\u1ec7u l\u1ef1c b\u1ea3o v\u1ec7 c\u01a1 quan nh\u01b0ng c\u00e1c chuy\u00ean gia v\u1eabn th\u1eeba nh\u1eadn cho \u0111\u1ebfn nay c\u00e1c thu\u1ed1c n\u00e0y v\u1eabn r\u1ea5t \u0111\u1eaft ti\u1ec1n. Hai nh\u00f3m thu\u1ed1c SGLT-2i v\u00e0 GLP-1 RA c\u00f3 th\u1ec3 \u0111\u01b0\u1ee3c kh\u1edfi tr\u1ecb b\u1ea5t k\u1ec3 vi\u1ec7c s\u1eed d\u1ee5ng metformin tr\u01b0\u1edbc \u0111\u00f3 hay m\u1ee9c HbA1c ban \u0111\u1ea7u. Trong \u0111i\u1ec1u ki\u1ec7n ngu\u1ed3n l\u1ef1c t\u1ea1i c\u01a1 s\u1edf y t\u1ebf c\u1ee7a b\u1ea1n h\u1ea1n ch\u1ebf, c\u00e1c thu\u1ed1c n\u00e0y n\u00ean \u0111\u01b0\u1ee3c \u01b0u ti\u00ean tr\u00ean nh\u00f3m BN c\u00f3 nguy c\u01a1 cao nh\u1ea5t, c\u1ea7n c\u00e2n nh\u1eafc d\u1ef1a tr\u00ean \u0111\u1ed9 gi\u1ea3m nguy c\u01a1 tuy\u1ec7t \u0111\u1ed1i (ARR) b\u00ean c\u1ea1nh \u0111\u1ed9 gi\u1ea3m nguy c\u01a1 t\u01b0\u01a1ng \u0111\u1ed1i (RRR).<\/li>\n<li>Nh\u00ecn chung, metformin v\u1eabn l\u00e0 l\u1ef1a ch\u1ecdn \u0111\u1ea7u tay tr\u00ean h\u1ea7u h\u1ebft c\u00e1c BN m\u1eafc \u0110T\u0110 type 2 nh\u01b0ng kh\u00f4ng ph\u1ea3i m\u1eb7c \u0111\u1ecbnh cho m\u1ecdi tr\u01b0\u1eddng h\u1ee3p . Tuy v\u1eady, metformin \u0111\u01a1n tr\u1ecb th\u01b0\u1eddng kh\u00f4ng \u0111\u1ee7 \u0111\u1ec3 duy tr\u00ec m\u1ee9c \u0111\u01b0\u1eddng huy\u1ebft m\u1ee5c ti\u00eau. Do v\u1eady, c\u00e1c \u0111\u1ed3ng thu\u1eadn tr\u01b0\u1edbc \u0111\u00f3 c\u0169ng \u0111\u00e3 \u0111\u1ec1 xu\u1ea5t c\u00e1c nh\u00f3m thu\u1ed1c kh\u00e1c c\u00f3 th\u1ec3 mang l\u1ea1i l\u1ee3i \u00edch trong vi\u1ec7c ph\u1ed1i h\u1ee3p v\u1edbi metformin ho\u1eb7c khi metformin b\u1ecb ch\u1ed1ng ch\u1ec9 \u0111\u1ecbnh hay kh\u00f4ng dung n\u1ea1p. Vi\u1ec7c l\u1ef1a ch\u1ecdn thu\u1ed1c trong \u0111i\u1ec1u tr\u1ecb \u0110T\u0110 type 2 n\u00ean c\u00e2n b\u1eb1ng gi\u1eefa hi\u1ec7u l\u1ef1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft v\u00e0 h\u1ed3 s\u01a1 an to\u00e0n c\u1ee7a t\u1eebng thu\u1ed1c.<\/li>\n<li>B\u1eb1ng ch\u1ee9ng m\u1edbi v\u1ec1 l\u1ee3i \u00edch c\u1ee7a c\u00e1c thu\u1ed1c c\u1ee5 th\u1ec3 tr\u00ean m\u1ed9t s\u1ed1 b\u1ec7nh m\u1eafc k\u00e8m \u0111\u00e3 \u0111\u01b0\u1ee3c c\u00f4ng b\u1ed1 nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y.<br \/>\na. \u0110\u1ed1i v\u1edbi BN m\u1eafc gan nhi\u1ec5m m\u1ee1 kh\u00f4ng do r\u01b0\u1ee3u (NAFLD\/NASH) c\u00f3 nguy c\u01a1 x\u01a1 h\u00f3a cao, pioglitazone c\u00f3 th\u1ec3 l\u00e0 l\u1ef1a ch\u1ecdn t\u1ed1t.<br \/>\nb. C\u00f3 th\u1ec3 l\u1ef1a ch\u1ecdn c\u00e1c lo\u1ea1i thu\u1ed1c m\u1edbi nh\u01b0 tirzepatide (\u0110\u1ed3ng v\u1eadn GIP v\u00e0 GLP-1) \u0111\u1ec3 v\u1eeba l\u00e0m h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft v\u1eeba gi\u1ea3m c\u00e2n.<br \/>\nc. Tr\u00ean BN CKD v\u00e0 eGFR \u226520 ml\/ph\u00fat\/1,73 m2 v\u00e0 UACR &gt;3,0 mg\/mmol (&gt;30 mg\/g), n\u00ean kh\u1edfi tr\u1ecb SGLT2i v\u1edbi l\u1ee3i \u00edch \u0111\u00e3 \u0111\u01b0\u1ee3c ch\u1ee9ng minh trong gi\u1ea3m MACE, c\u1ea3i thi\u1ec7n suy tim v\u00e0 c\u00e1c k\u1ebft c\u1ee5c tr\u00ean th\u1eadn. (Xem l\u1ea1i c\u00e1ch chia \u0111\u1ea7u m\u1ee5c)<\/li>\n<li>C\u00e2n nh\u1eafc s\u1eed d\u1ee5ng GLP-1 RA tr\u01b0\u1edbc khi kh\u1edfi tr\u1ecb b\u1eb1ng insulin. Khi \u0111\u00e3 kh\u1edfi tr\u1ecb b\u1eb1ng insulin, ti\u1ebfp t\u1ee5c s\u1eed d\u1ee5ng c\u00e1c thu\u1ed1c h\u1ea1 \u0111\u01b0\u1eddng huy\u1ebft b\u1ea3o v\u1ec7 c\u01a1 quan v\u00e0 metformin.<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, metformin \u0111\u00e3 tr\u1edf th\u00e0nh m\u1ed9t lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng r\u1ed9ng r\u00e3i trong \u0111i\u1ec1u tr\u1ecb \u0111\u00e1i th\u00e1o \u0111\u01b0\u1eddng type 2. V\u1edbi kh\u1ea3 n\u0103ng gi\u1ea3m \u0111\u01b0\u1eddng huy\u1ebft hi\u1ec7u qu\u1ea3 v\u00e0 ti\u00eau hao \u00edt nguy\u00ean li\u1ec7u n\u0103ng l\u01b0\u1ee3ng so v\u1edbi c\u00e1c thu\u1ed1c kh\u00e1c, metformin \u0111\u00e3 tr\u1edf th\u00e0nh l\u1ef1a ch\u1ecdn h\u00e0ng \u0111\u1ea7u trong [&hellip;]<\/p>\n","protected":false},"author":19,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":[],"categories":[12,33],"tags":[],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v20.4 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Metformin-kh\u00f4ng c\u00f2n l\u00e0 thu\u1ed1c \u0111\u1ea7u tay m\u1eb7c \u0111\u1ecbnh cho m\u1ecdi b\u1ec7nh nh\u00e2n \u0110T\u0110 Type 2<\/title>\n<meta name=\"description\" content=\"Trong nh\u1eefng n\u0103m g\u1ea7n \u0111\u00e2y, metformin \u0111\u00e3 tr\u1edf th\u00e0nh m\u1ed9t lo\u1ea1i thu\u1ed1c \u0111\u01b0\u1ee3c s\u1eed d\u1ee5ng 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