Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence
Insulin Analogs: Impact on Treatment Success, Satisfaction, Quality of Life, and Adherence
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DOI：
10.3121/cmr.2008.793
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发表时间：
2008-09-01
影响因子：
1.4
通讯作者：
Hartman, Israel
中科院分区：
文献类型：
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作者：
Hartman, Israel
越来越多的医学研究表明，严格控制血糖水平可以最大限度地减少糖尿病相关并发症的发生。胰岛素管理的成功最终取决于给定方案与正常生理胰岛素释放模式的模拟程度。新的胰岛素类似物，包括速效类似物（天冬氨酸、利斯普罗、甘氨酸）、长效基础类似物（甘精氨酸、地替米尔）和预混胰岛素类似物制剂（75%中性鱼精蛋白利斯普罗、25%利斯普罗、50%中性鱼精蛋白利斯普罗、50%利斯普罗、70%鱼精蛋白天冬氨酸、30%天冬氨酸）已被配制成更接近正常胰岛素谱的复制。速效类似物可以在用餐时施用，并产生快速而短暂的胰岛素峰值，以解决餐后血糖升高问题，而长效类似物接近理想的平稳，相对平坦的24小时基础胰岛素供应，与NPH胰岛素相比，作用变异性较小。尽管有这些明显的药理学优势，但在糖尿病等复杂疾病中可测量的临床益处可能难以测量。迄今为止，对胰岛素类似物研究的回顾尚未发现与传统人胰岛素相比，糖化血红蛋白（HbA1c）结果有显著的总体改善，尽管在一些研究中，全类似物基础灌注方案的HbA1c显著低于全人胰岛素基础灌注方案。然而，除了HbA1c比较外，胰岛素类似物在许多情况下显示与较低的低血糖风险、较低的餐后血糖漂移水平、更好的患者依从性、更高的生活质量和更高的治疗满意度相关。长效基础类似物胰岛素detemir具有产生较少体重增加的额外优势，这一直被认为是胰岛素替代的几乎不可避免的后果。
A growing body of medical research has demonstrated that intensive control of serum glucose levels can minimize the development of diabetes-related complications. Success with insulin management ultimately depends on how closely a given regimen can mimic normal physiologic insulin release patterns. The new insulin analogs, including the rapid-acting analogs (aspart, lispro, glulisine), the long-acting basal analogs (glargine, detemir), and the premixed insulin analog formulations (75% neutral protamine lispro, 25% lispro; 50% neutral protamine lispro, 50% lispro; 70% protamine aspart, 30% aspart) have been formulated to allow for a closer replication of a normal insulin profile. The rapid-acting analogs can be administered at mealtimes and produce a rapid and short-lived insulin spike to address postprandial glucose elevations, while the long-acting analogs come close to the ideal of a smooth, relatively flat, 24-hour basal insulin supply, with less variability in action compared to NPH insulin. Despite these clear pharmacologic advantages, measurable clinical benefits in a complex disease such as diabetes can be hard to measure. To date, reviews of insulin analog studies have not found a dramatic overall improvement in glycosylated hemoglobin (HbA1c) outcomes compared to traditional human insulins, although all-analog basal-bolus regimens were associated with significantly lower HbA1c than all-human-insulin basal bolus regimens in some studies. Beyond HbA1c comparisons, however, insulin analogs have been shown in many instances to be associated with lower risks of hypoglycemia, lower levels of postprandial glucose excursions, better patient adherence, greater quality of life, and higher satisfaction with treatment. The long-acting basal analog insulin detemir has the additional advantage of producing less weight gain, which has been considered until now an almost inevitable consequence of insulin replacement.