Bethel M Angelyn, Feinglos Mark N
Division of Endocrinology, Metabolism, and Nutrition, Duke University Medical Center, Durham, North Carolina 27710, USA.
J Am Board Fam Pract. 2005 May-Jun;18(3):199-204. doi: 10.3122/jabfm.18.3.199.
Patients with type 2 diabetes mellitus are usually treated initially with oral antidiabetic agents, but as the disease progresses, most patients eventually require insulin to maintain glucose control. Optimal insulin therapy should mimic the normal physiologic secretion of insulin and minimize the risk of hypoglycemia. This article discusses the role of insulin therapy in patients with type 2 diabetes, emphasizing long-acting insulin agents designed to approximate physiologic basal insulin secretion and provide control over fasting plasma glucose. Clinical trials of recently developed long-acting insulins are reviewed herein, with emphasis on studies that combined basal insulin with oral agents or with short-acting insulins in a basal-bolus approach. The normal physiologic pattern of insulin secretion by pancreatic beta cells consists of a sustained basal insulin level throughout the day, superimposed after meals by relatively large bursts of insulin that slowly decay over 2 to 3 hours (bolus insulin). Basal support with long-acting insulin is a key component of basal-bolus therapy for patients with diabetes who require insulin with or without the addition of oral agents. Newer long-acting agents such as insulin glargine provide a steadier and more reliable level of basal insulin coverage and may have significant advantages over traditional long-acting insulins as part of a basal-bolus treatment strategy.
2型糖尿病患者通常最初采用口服抗糖尿病药物治疗，但随着疾病进展，大多数患者最终需要胰岛素来维持血糖控制。最佳胰岛素治疗应模拟胰岛素的正常生理分泌，并将低血糖风险降至最低。本文讨论胰岛素治疗在2型糖尿病患者中的作用，重点介绍旨在近似生理基础胰岛素分泌并控制空腹血糖的长效胰岛素制剂。本文综述了最近开发的长效胰岛素的临床试验，重点是将基础胰岛素与口服药物或短效胰岛素联合采用基础-餐时给药法的研究。胰腺β细胞正常的胰岛素生理分泌模式包括全天持续的基础胰岛素水平，餐后叠加相对大量的胰岛素脉冲，这些脉冲在2至3小时内缓慢衰减（餐时胰岛素）。对于需要胰岛素治疗（无论是否加用口服药物）的糖尿病患者，长效胰岛素提供基础支持是基础-餐时治疗的关键组成部分。新型长效制剂如甘精胰岛素可提供更稳定、更可靠的基础胰岛素覆盖水平，作为基础-餐时治疗策略的一部分，可能比传统长效胰岛素具有显著优势。
