Intensifying insulin therapy in patients with type 2 diabetes mellitus
Intensifying insulin therapy in patients with type 2 diabetes mellitus
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DOI：
10.1016/j.amjmed.2005.04.011
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发表时间：
2005-05-01
影响因子：
5.9
通讯作者：
Hirsch, IB
中科院分区：
文献类型：
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作者：
Hirsch, IB
目前2型糖尿病（DM）的药物治疗模式是口服药物治疗，直至出现严重胰岛素缺乏，此时可以开始胰岛素治疗。对糖尿病控制和并发症试验（DC，CT）数据的重新检查表明，血糖变异性可能是参与微血管并发症发病机制的重要因素。是的现在认识到，来自活性氧物质的过度产生的氧化应激可能是这种血糖变化性的结果，这表明过度注射基础胰岛素可能不是胰岛素替代的理想策略，即使基础胰岛素通常是最初使用的唯一胰岛素。虽然寻找治疗2型糖尿病的最佳胰岛素方案是一个重要的研究领域，但几乎所有严重胰岛素缺乏的患者都需要基础和餐时替代。使用足够的滞后时间（注射餐时胰岛素和进食之间的时间）、U-500胰岛素（500 U/mL人常规胰岛素）和家庭血糖监测来确定“血糖趋势”是所有患者都可以使用的重要工具。(c)2005年爱思唯尔公司All rights reserved.
The current paradigm for pharmacologic management of type 2 diabetes mellitus (DM) is to progress with oral agents until severe insulin deficiency develops, at which time insulin can be initiated. Reexamination of data from the Diabetes Control and Complications Trial (DC, CT) suggests that glycemic variability may be an important factor involved in the pathogenesis of microvascular complications. It is. now appreciated that oxidative stress from overproduction of reactive oxygen species may be the result of this glycemic variability, suggesting that an overemphasis of basal insulin may not be the ideal strategy for insulin replacement, even though basal insulin is often the only insulin used initially. Although finding the best insulin program for treatment of type 2 DM is an important area of research, almost all patients with severe insulin deficiency will require both basal and prandial replacement. Use of adequate lag times (time between injecting the prandial insulin and eating), U-500 insulin (500 U/mL human regular insulin), and home blood glucose monitoring to determine "glycemic trend" are important tools that are readily available to all patients. (c) 2005 Elsevier Inc. All rights reserved.