Basal Insulin Intensification in Patients with Type 2 Diabetes: A Review.
Basal Insulin Intensification in Patients with Type 2 Diabetes: A Review.
复制标题
DOI：
10.1007/s13300-018-0395-3
复制
发表时间：
2018-06
期刊：
影响因子：
--
通讯作者：
Meece J
中科院分区：
文献类型：
--
作者：
Meece J
随着 2 型糖尿病 (T2D) 患者数量持续增加，管理他们的复杂需求给医生带来了越来越大的挑战。虽然治疗指南提供了基于证据的指导，但它们并不是规定性的，而是强调根据患者的临床需求和偏好进行个体化管理。因此，医生需要充分了解在疾病的每个阶段可用的多种且不断增加的治疗选择的优点和缺点。 T2D 的进展性意味着基础胰岛素治疗对于许多患者来说将是不可避免的，而对于某些患者来说，仅基础胰岛素最终不足以维持血糖目标。最近的指南推荐了两种强化基础胰岛素的基本方法：使用速效胰岛素，作为额外的餐时注射或作为预混（双相）胰岛素的一部分；在胰岛素治疗中添加胰高血糖素样肽-1受体激动剂（GLP-1 RA），可以通过皮下注射每天一次或两次或每周一次（具体取决于配方）。最近，基础胰岛素和 GLP-1 RA 的两种固定比例组合已获得批准，允许每日一次给药。这些方法都有潜在的优点和缺点，特别是在低血糖风险、体重变化、便利性和副作用方面。了解这些差异对于指导患者和医生的选择至关重要。本文讨论了目前可用的 T2D 患者基础胰岛素强化治疗策略的基本原理、优点、缺点和实施。资金来源：赛诺菲美国公司
As the number of people living with type 2 diabetes (T2D) continues to rise, managing their complex needs presents an increasing challenge to physicians. While treatment guidelines provide evidence-based guidance, they are not prescriptive—rather they emphasize individualization of management based on a patient’s clinical needs and preferences. Physicians, therefore, need to be fully aware of the advantages and disadvantages of the multiple and increasing treatment options available to them at each stage of the disease. The progressive nature of T2D means that treatment with basal insulin will become inevitable for many patients, while for some patients basal insulin alone will eventually be insufficient for maintaining glycemic targets. Recent guidelines recommend two basic approaches for intensifying basal insulin: the use of rapid-acting insulin, either as additional prandial injections or as part of premix (biphasic) insulin; and the addition of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) to the insulin therapy, which can be administered via subcutaneous injection once or twice daily, or weekly depending on formulation. More recently, two fixed-ratio combinations of basal insulin and a GLP-1 RA that allow for once-daily dosing have been approved. Each of these approaches has potential benefits and drawbacks, particularly in terms of risk for hypoglycemia, weight change, convenience, and side effects. Understanding these differences is central to guiding patient and physician choice. This article discusses the rationale, advantages, disadvantages, and implementation of currently available strategies for basal insulin treatment intensification in patients with T2D. Funding: Sanofi US, Inc.
登录
查看更多内容
DOI：
10.1111/dom.12498
发表时间：
2015-10
期刊：
Diabetes, obesity & metabolism
影响因子：
--
作者：
Gough SC;Bode BW;Woo VC;Rodbard HW;Linjawi S;Zacho M;Reiter PD;Buse JB
通讯作者：
Buse JB
影响因子：
168.9
作者：
Eng, Conrad;Kramer, Caroline K.;Retnakaran, Ravi
通讯作者：
Retnakaran, Ravi
影响因子：
4.7
作者：
de Vries, Sieta T.;Keers, Joost C.;Denig, Petra
通讯作者：
Denig, Petra
影响因子：
--
作者：
Kalra S;Mukherjee JJ;Venkataraman S;Bantwal G;Shaikh S;Saboo B;Das AK;Ramachandran A
通讯作者：
Ramachandran A
影响因子：
16.2
作者：
Buse, John B.;Vilsboll, Tina;Rodbard, Helena W.
通讯作者：
Rodbard, Helena W.