Riddle Matthew C
Division of Endocrinology, Diabetes, and Clinical Nutrition, Oregon Health Sciences University, Portland, OR 97201, USA.
Diabetes Metab Res Rev. 2002 Sep-Oct;18 Suppl 3:S42-9. doi: 10.1002/dmrr.277.
At least 8% of the combined population of the United States (US) and Canada have diabetes, and in about one-third of these people, the disease is undiagnosed [1]. Diabetes is not evenly distributed geographically, and there is surprisingly little consensus among categories of medical providers as to when and how intensive insulin therapy should be initiated. Although some physicians worry that insulin therapy may promote insulin resistance or increase the risk of cardiovascular events, the best current clinical evidence suggests that such fears are largely unfounded. Similarly, new evidence shows that the weight gain associated with insulin therapy is by no means always dramatic or progressive. The view that insulin is not effective in type 2 diabetes, although common in the US, is not shared by physicians experienced and skillful in its use and is refuted by recent clinical studies. Promising new patterns of insulin use in type 2 patients are emerging in the US: the availability of insulin as a single dose, rather than moving directly to multiple daily injections; the practice of continuing rather than stopping oral agents when an evening insulin dose is added; and the use of new insulins and insulin-sensitizing agents that facilitate therapy and increase its effectiveness. Several new treatment options are discussed.
美国和加拿大的总人口中至少8%患有糖尿病，其中约三分之一的患者未被诊断出来[1]。糖尿病在地理上分布不均，而且在何时以及如何开始强化胰岛素治疗方面，各类医疗服务提供者之间的共识出奇地少。尽管一些医生担心胰岛素治疗可能会促进胰岛素抵抗或增加心血管事件的风险，但目前最好的临床证据表明，这种担忧在很大程度上是没有根据的。同样，新证据表明，与胰岛素治疗相关的体重增加绝非总是显著或渐进的。胰岛素对2型糖尿病无效的观点，尽管在美国很普遍，但有经验和技术娴熟的医生并不认同，并且最近的临床研究也反驳了这一观点。美国正在出现2型患者使用胰岛素的有前景的新模式：提供单次剂量的胰岛素，而不是直接过渡到每日多次注射；在添加晚间胰岛素剂量时继续使用口服药物而非停药的做法；以及使用有助于治疗并提高其有效性的新型胰岛素和胰岛素增敏剂。文中讨论了几种新的治疗选择。
