Cernea Simona, Raz Itamar
Division of Endocrinology, Department of Medicine, Columbia University, New York, New York, USA.
Timely Top Med Cardiovasc Dis. 2006 Nov 1;10:E29.
Optimal glycemic control is essential for the prevention of diabetes-related complications, and the intensive insulin regimens that best resemble physiological insulin secretion are most likely to attain it. However, there are many limitations that preclude the early use of insulin by patients with type 2 diabetes or wider implementation of the intensive regimens in type 1 diabetes. More acceptable alternative routes of insulin administration and effective, noninvasive, patient-friendly delivery systems that alleviate the burden of insulin injections have been researched over the years. To date, only pulmonary inhalation of insulin has become a feasible alternative; it has proved to be as effective and well tolerated as the subcutaneously injected regular insulin and it has a pharmacodynamic profile well suited for mealtime insulin therapy. Several pulmonary insulin delivery systems are in different stages of development, and one (Exubera, Nektar Therapeutics/Pfizer Inc.-Sanofi-Aventis Group) has already become clinically available in the United States and Europe for patients with diabetes. Other noninjectable methods of insulin administration are reviewed.
最佳血糖控制对于预防糖尿病相关并发症至关重要，而最接近生理胰岛素分泌的强化胰岛素治疗方案最有可能实现这一目标。然而，存在许多限制因素，使得2型糖尿病患者无法早期使用胰岛素，或无法在1型糖尿病中更广泛地实施强化治疗方案。多年来，人们一直在研究更可接受的胰岛素给药替代途径以及有效、无创、对患者友好的给药系统，以减轻胰岛素注射的负担。迄今为止，只有胰岛素肺部吸入已成为一种可行的替代方法；它已被证明与皮下注射常规胰岛素一样有效且耐受性良好，并且其药效学特征非常适合餐时胰岛素治疗。几种肺部胰岛素给药系统正处于不同的开发阶段，其中一种（Exubera，Nektar Therapeutics/辉瑞公司 - 赛诺菲 - 安万特集团）已在美国和欧洲用于糖尿病患者的临床治疗。本文还综述了其他非注射胰岛素给药方法。
