Insulin analogs--is there a compelling case to use them? No!
Insulin analogs--is there a compelling case to use them? No!
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DOI：
10.2337/dc13-2915
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发表时间：
2014-06
期刊：
影响因子：
16.2
通讯作者：
Davidson MB
中科院分区：
文献类型：
--
作者：
Davidson MB
胰岛素类似物的可用性提供了胰岛素替代策略，这些策略被提出来更接近地模拟正常人类生理学。具体而言，有相当多的报告表明，餐时胰岛素类似物（赖脯胰岛素、门冬胰岛素、赖谷胰岛素）的药代动力学和药效学特征更接近正常，与常规人胰岛素相比，胰岛素效应的起效和抵消更快。此外，据报道，基础胰岛素类似物（甘精胰岛素、地特胰岛素）的作用持续时间更长、变异性更小、可预测性更强、低血糖（尤其是夜间）更少，对体重的影响也更有利。然而，与使用常规或NPH胰岛素相比，反对使用胰岛素类似物的论点是，低血糖的有效性和风险是唯一两个有效的临床结局，应用于比较胰岛素类似物和人胰岛素。因此，在某些圈子中仍然存在一种争论，即模拟胰岛素并不比人胰岛素更有效，但经济成本要高得多。为了深入了解双方的论点，我们提供了一个讨论这个话题的一部分，这两部分点对位叙事。在这里呈现的对位叙述中，戴维森博士提供了他的论点并捍卫了他的观点，即除了少数例外情况之外，与人胰岛素相比，模拟胰岛素没有提供临床益处，但成本要高得多。在前面的叙述中，Grunberger博士为类似胰岛素及其在临床管理中的价值进行了辩护，并建议在评估治疗的“成本”时，需要进行更全面的评估。- 威廉·T Cefalu主编，糖尿病护理
The availability of insulin analogs has offered insulin replacement strategies that are proposed to more closely mimic normal human physiology. Specifically, there are a considerable number of reports demonstrating that prandial insulin analogs (lispro, aspart, glulisine) have pharmacokinetic and pharmacodynamic profiles closer to normal, with resulting faster onset and offset of insulin effect when compared with regular human insulin. In addition, basal insulin analogs (glargine, detemir) have been reported to offer longer duration of action, less variability, more predictability, less hypoglycemia (especially nocturnal), and a favorable effect on weight. However, an argument against use of analog insulins as compared with use of regular or NPH insulin is one that states that the effectiveness and risk of hypoglycemia are the only two valid clinical outcomes that should be used to compare the analog and human insulins. Thus, there remains a debate in some circles that analog insulins are no more effective than human insulins, yet at a much higher financial cost. To provide an in-depth understanding of both sides of the argument, we provide a discussion of this topic as part of this two-part point-counterpoint narrative. In the counterpoint narrative presented here, Dr. Davidson provides his argument and defends his opinion that outside of a few exceptions, analog insulins provide no clinical benefit compared with human insulins but cost much more. In the preceding point narrative, Dr. Grunberger provides a defense of analog insulins and their value in clinical management and suggests that when evaluating the “cost” of therapy, a much more global assessment is needed. —William T. Cefalu Editor in Chief, Diabetes Care
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影响因子：
168.9
作者：
Turner, RC;Holman, RR;Ward, JD
通讯作者：
Ward, JD
影响因子：
16.2
作者：
Renner, R;Pfútzner, A;Landgraf, R
通讯作者：
Landgraf, R
影响因子：
5.1
作者：
OHKUBO, Y;KISHIKAWA, H;SHICHIRI, M
通讯作者：
SHICHIRI, M
影响因子：
7.7
作者：
Eliaschewitz, FG;Calvo, C;Jimenez, J
通讯作者：
Jimenez, J
影响因子：
16.2
作者：
Holleman, F;Schmitt, H;Anderson, JH
通讯作者：
Anderson, JH