Bode Bruce W
Atlanta Diabetes Associates, Atlanta, Georgia 30309, USA.
Clin Ther. 2007;29 Suppl D:S135-44. doi: 10.1016/j.clinthera.2007.12.013.
Replicating endogenous insulin production is the goal of treatment for diabetes mellitus (DM) and is necessary to minimize the risk of vascular complications. The 2 main methods of achieving this goal are continuous subcutaneous insulin infusion (CSII) and multiple daily injections (MDIs) comprising basal and prandial injections.
The objective of this article was to discuss the use of a rapid-acting insulin analogue, insulin aspart, in CSII and MDI compared with other insulins in adult patients with type 1 or type 2 DM.
This article was based on a presentation given by the author at a satellite symposium entitled "Realising the Value of Modern Insulins: Reaching Further with Rapid-Acting Insulin Analogues" that was convened during the XIXth World Diabetes Congress, December 3, 2006, in Cape Town, South Africa.
In patients with type 1 DM, CSII using the rapid-acting insulin analogue insulin aspart has been reported in clinical trials to improve glycemic control compared with MDI therapy using neutral protamine Hagedorn plus insulin aspart (for basal and mealtime coverage, respectively). In patients with type 2 DM, the CSII and MDI regimens offered similar efficacy and tolerability; CSII therapy may be less burdensome, however, with fewer social limitations than MDIs. Not all insulins are equally suited for use in CSII treatment. Although the efficacy of insulin aspart in CSII was comparable to other rapid-acting insulins, the frequency of hypoglycemia was shown to be significantly lower with insulin aspart compared with human insulin or insulin lispro in patients with type 1 DM. The compatibility of insulin aspart and insulin lispro for use in CSII pumps was compared in an 8-week, double-blind, 2-period, crossover study of patients with type 1 DM. The overall adverse-effect score was significantly lower (P<0.005) with insulin aspart than with insulin lispro, as were scores for pain/burning and inflammation (both, P<0.01) and dermal redness (P<0.001). Furthermore, a stability study reported on the suitability of insulin aspart for use in CSII pumps. Quality-of-life scores with CSII have been reported to be higher than with MDI therapy.
CSII with the rapid-acting insulin analogue insulin aspart is a viable choice for patients with type 1 or type 2 DM who want close-to-physiologic insulin treatment.
复制内源性胰岛素分泌是糖尿病（DM）治疗的目标，对于将血管并发症风险降至最低至关重要。实现这一目标的两种主要方法是持续皮下胰岛素输注（CSII）和包括基础注射和餐时注射的每日多次注射（MDI）。
本文旨在探讨速效胰岛素类似物门冬胰岛素在CSII和MDI中的应用，并与1型或2型糖尿病成年患者使用的其他胰岛素进行比较。
本文基于作者在2006年12月3日于南非开普敦召开的第19届世界糖尿病大会期间举办的名为“认识现代胰岛素的价值：速效胰岛素类似物的进一步应用”的卫星研讨会上的发言。
在1型糖尿病患者中，临床试验报告显示，与使用中性鱼精蛋白锌胰岛素加门冬胰岛素（分别用于基础和餐时覆盖）的MDI治疗相比，使用速效胰岛素类似物门冬胰岛素的CSII可改善血糖控制。在2型糖尿病患者中，CSII和MDI方案具有相似的疗效和耐受性；然而，CSII治疗可能负担较小，社会限制比MDI少。并非所有胰岛素都同样适用于CSII治疗。虽然门冬胰岛素在CSII中的疗效与其他速效胰岛素相当，但在1型糖尿病患者中，与普通胰岛素或赖脯胰岛素相比，门冬胰岛素导致低血糖的频率显著更低。在一项针对1型糖尿病患者的为期8周的双盲、两阶段交叉研究中，比较了门冬胰岛素和赖脯胰岛素在CSII泵中的兼容性。门冬胰岛素的总体不良反应评分显著低于赖脯胰岛素（P<0.005），疼痛/烧灼感和炎症评分（均为P<0.01）以及皮肤发红评分（P<0.001）也是如此。此外，一项稳定性研究报告了门冬胰岛素用于CSII泵的适用性。据报道，CSII的生活质量评分高于MDI治疗。
对于希望接受接近生理胰岛素治疗的1型或2型糖尿病患者，使用速效胰岛素类似物门冬胰岛素的CSII是一种可行的选择。
