Marrero David G
Division of Endocrinology & Metabolism, Indiana University School of Medicine, 250 N. University Blvd., Suite 122, Indianapolis, IN 46202, USA.
Clin Cornerstone. 2008;9(2):63-70; discussion 71-3. doi: 10.1016/s1098-3597(09)62041-x.
Data from clinical trials underscore the fact that loss of beta-cell function and insulin hyposecretion are progressive in type 2 diabetes. To achieve adequate glycemic control, most patients will eventually require insulin. Addition of insulin to sulfonylurea therapy, when maximal sulfonylurea does not adequately maintain fasting plasma glucose levels at < 108 mg/dL, has been found to be more effective than initiating insulin therapy after oral agents have failed to maintain glycemic control. Nonetheless, both patients and providers are reluctant to begin insulin therapy. Research has shown that providers often delay modification of the diabetes treatment regimen because they believe their patients would be concerned about starting insulin therapy. In addition, they are concerned about patient nonadherence to nonpharmacologic and pharmacologic therapy. There are multiple reasons for patient nonadherence to insulin therapy; however, patients must be made to understand, early in the course of the disease, the progressive nature of type 2 diabetes and that exogenous insulin is an additional therapeutic option to help them achieve and maintain adequate glycemic control.
临床试验数据强调了这样一个事实，即2型糖尿病患者的β细胞功能丧失和胰岛素分泌不足是渐进性的。为了实现充分的血糖控制，大多数患者最终都需要胰岛素。当最大剂量的磺脲类药物不能将空腹血糖水平充分维持在<108mg/dL时，在磺脲类药物治疗基础上加用胰岛素已被证明比在口服药物未能维持血糖控制后开始胰岛素治疗更有效。尽管如此，患者和医护人员都不愿意开始胰岛素治疗。研究表明，医护人员常常推迟调整糖尿病治疗方案，因为他们认为患者会担心开始胰岛素治疗。此外，他们还担心患者不坚持非药物和药物治疗。患者不坚持胰岛素治疗有多种原因；然而，必须让患者在疾病早期就了解2型糖尿病的渐进性本质，以及外源性胰岛素是帮助他们实现并维持充分血糖控制的一种额外治疗选择。
