The role of new basal insulin analogues in the initiation and optimisation of insulin therapy in type 2 diabetes
The role of new basal insulin analogues in the initiation and optimisation of insulin therapy in type 2 diabetes
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DOI：
10.1007/s00592-008-0052-9
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发表时间：
2008-12-01
影响因子：
3.8
通讯作者：
Baxter, Mike A.
中科院分区：
文献类型：
--
作者：
Baxter, Mike A.
在2型糖尿病（T2DM）的治疗中，旨在实现正常血糖的强化胰岛素治疗越来越被接受，以降低糖尿病相关并发症的风险。胰岛素治疗越来越多地与口服降糖药（OAD）联合使用，以调节胰岛素剂量，减少体重增加并提供心血管保护。然而，传统胰岛素存在局限性，这些局限性可能成为胰岛素治疗启动和强化使用的障碍。与中性鱼精蛋白哈格多恩胰岛素（NPH）相比，新型长效基础胰岛素类似物（如甘精胰岛素（甘精胰岛素）和地特胰岛素（地特胰岛素））的出现改善了药代动力学和药效学特征。这可能会同时改善血液病控制的安全性、有效性和变异性。本文综述了这些新的长效基础胰岛素类似物的性质及其在促进胰岛素治疗的启动和优化中的潜在作用。使用Medline识别报告使用胰岛素和胰岛素类似物治疗T2DM的研究。关键检索词包括：“甘精胰岛素”、"地特胰岛素“、”NPH胰岛素“、”基础胰岛素“、”长效胰岛素"、“胰岛素类似物"、”药代动力学“、”药效学“、”剂量滴定“、”算法“和”2型糖尿病“。还检索了美国糖尿病协会和欧洲糖尿病研究协会年会上发表的摘要。数据显示，长效胰岛素类似物甘精胰岛素和地特胰岛素均提供低血糖风险和改善的血糖控制。甘精胰岛素和地特胰岛素的积极剂量滴定有助于实现血糖控制目标。使用新型胰岛素治疗作为简单基础胰岛素方案的一部分，持续使用OAD，实现良好血糖控制和低血糖风险的目标可能更可行。
Intensive insulin therapy aimed at achieving normoglycaemia is becoming increasingly accepted in the treatment of type 2 diabetes (T2DM) to reduce the risk of diabetes-related complications. Insulin therapy is increasingly combined with oral antidiabetic drugs (OADs) to moderate insulin dosage, reduce weight gain and confer cardiovascular protection. However, traditional insulins are associated with limitations that may act as barriers to initiation, and intensive use of insulin therapy. The advent of newer, longer-acting, basal insulin analogues, such as insulin glargine (glargine) and insulin detemir (detemir), offer improved pharmacokinetic and pharmacodynamic profiles compared with neutral protamine Hagedorn insulin (NPH). This potentially provides concomitant improvements in safety, efficacy and variability of glycaemic control. This paper reviews the properties of these new long-acting, basal insulin analogues and their potential roles in facilitating the initiation and optimisation of insulin therapy. Studies that reported the use of insulin and insulin analogues for the treatment of T2DM were identified using Medline. Key search terms included: 'insulin glargine', 'insulin detemir', 'NPH insulin', 'basal insulin', 'long-acting insulin', 'insulin analogue', 'pharmacokinetics', 'pharmacodynamics', 'dose titration', 'algorithms' and 'type 2 diabetes'. Abstracts presented at the American Diabetes Association and the European Association for the Study of Diabetes annual congresses were also searched. The data show that the long-acting insulin analogues glargine and detemir both offer a low risk of hypoglycaemia and improved glycaemic control. Aggressive dose titration with glargine and detemir facilitates attainment of glycaemic control targets. The goal of achieving good glycaemic control with a low risk of hypoglycaemia may be more feasible with newer insulin therapies as part of a simple basal insulin regimen with continued OADs.