Use of rapid-acting insulin analogues in the treatment of patients with type 1 and type 2 diabetes mellitus: Insulin pump therapy versus multiple daily injections
Use of rapid-acting insulin analogues in the treatment of patients with type 1 and type 2 diabetes mellitus: Insulin pump therapy versus multiple daily injections
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DOI：
10.1016/j.clinthera.2007.12.013
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发表时间：
2007-01-01
影响因子：
3.2
通讯作者：
Bode, Bruce W.
中科院分区：
文献类型：
--
作者：
Bode, Bruce W.
背景资料：复制内源性胰岛素的产生是糖尿病（DM）治疗的目标，并且对于最小化血管并发症的风险是必要的。实现这一目标的两种主要方法是连续皮下胰岛素输注（CSII）和每日多次注射（MDI），包括基础和餐时注射。目的：本文的目的是讨论使用速效胰岛素类似物门冬胰岛素，在CSII和MDI与其他胰岛素相比，在1型或2型糖尿病成人患者。方法：本文基于作者在2006年12月3日于南非开普敦召开的第19届世界糖尿病大会期间召开的题为“实现现代胰岛素的价值：用速效胰岛素类似物进一步研究”的卫星研讨会上的演讲。在1型DM患者中，临床试验中报告了使用速效胰岛素类似物门冬胰岛素的CSII与使用中性鱼精蛋白哈格多恩+门冬胰岛素的MDI治疗（分别用于基础和餐时覆盖）相比，可改善血糖控制。在2型糖尿病患者中，CSII和MDI方案提供了相似的疗效和耐受性; CSII治疗可能负担较轻，但是，与MDI相比，社会限制较少。并非所有胰岛素都同样适用于CSII治疗。尽管门冬胰岛素在CSII中的疗效与其他速效胰岛素相当，但在1型DM患者中，门冬胰岛素的低血糖发生率显著低于人胰岛素或赖脯胰岛素。在1型DM患者中进行的一项为期8周、双盲、2阶段、交叉研究中，比较了门冬胰岛素和赖脯胰岛素用于CSII泵的相容性。门冬胰岛素的总体不良反应评分显著低于赖脯胰岛素（P < 0.005），疼痛/烧灼感和炎症评分（均为P < 0.01）和皮肤发红评分（P < 0.001）也是如此。此外，一项稳定性研究报告了门冬胰岛素用于CSII泵的适用性。据报道，CSII治疗的生活质量评分高于MDI治疗。结论：对于想要接近生理胰岛素治疗的1型或2型DM患者来说，CSII联合速效胰岛素类似物门冬胰岛素是一个可行的选择。
Background: Replicating endogenous insulin production is the goal of treatment for diabetes mellitus (DM) and is necessary to minimize the risk of vascular complications. The 2 main methods of achieving this goal are continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDIs) comprising basal and prandial injections.Objective: The objective of this article was to discuss the use of a rapid-acting insulin analogue, insulin aspart, in CSII and MDI compared with other insulins in adult patients with type 1 or type 2 DM.Methods: This article was based on a presentation given by the author at a satellite symposium entitled "Realising the Value of Modern Insulins: Reaching Further with Rapid-Acting Insulin Analogues" that was convened during the XIXth World Diabetes Congress, December 3, 2006, in Cape Town, South Africa.Results: In patients with type 1 DM, CSII using the rapid-acting insulin analogue insulin aspart has been reported in clinical trials to improve glycemic control compared with MDI therapy using neutral protamine Hagedorn plus insulin aspart (for basal and mealtime coverage, respectively). In patients with type 2 DM, the CSII and MDI regimens offered similar efficacy and tolerability; CSII therapy may be less burdensome, however, with fewer social limitations than MDIs. Not all insulins are equally suited for use in CSII treatment. Although the efficacy of insulin aspart in CSII was comparable to other rapid-acting insulins, the frequency of hypoglycemia was shown to be significantly lower with insulin aspart compared with human insulin or insulin lispro in patients with type 1 DM. The compatibility of insulin aspart and insulin lispro for use in CSII pumps was compared in an 8-week, double-blind, 2-period, crossover study of patients with type 1 DM. The overall adverse-effect score was significantly lower (P < 0.005) with insulin aspart than with insulin lispro, as were scores for pain/burning and inflammation (both, P < 0.01) and dermal redness (P < 0.001). Furthermore, a stability study reported on the suitability of insulin aspart for use in CSII pumps. Quality-of-life scores with CSII have been reported to be higher than with MDI therapy.Conclusion: CSII with the rapid-acting insulin analogue insulin aspart is a viable choice for patients with type 1 or type 2 DM who want close-to-physiologic insulin treatment.