Healing Our Village, Inc, and Emory University School of Medicine, Atlanta, GA (Dr Gavin)
The Diabetes Education Center, Winthrop-University Hospital, Mineola, NY (Ms Peragallo-Dittko)
Diabetes Educ. 2010 May-Jun;36 Suppl 2:26S-38S; quiz 39S-40S. doi: 10.1177/0145721710369637.
Current evidence shows early initiation of insulin therapy in type 2 diabetes mellitus (T2DM) improves glycemic control, responsiveness to subsequent oral antidiabetic therapies, beta-cell function, and possible cardiovascular outcomes. The American Diabetes Association (ADA)/European Association for the Study of Diabetes (EASD) 2008 algorithm introduces insulin therapy earlier in the treatment of T2DM with prompt intensification to achieve therapeutic goals. Agent selection and insulin regimens are based on patient A1C levels and willingness to monitor blood glucose, use of previous medications, blood glucose patterns, diet, and lifestyle. Practical considerations offered for diabetes educators and clinicians include creating strategies for early initiation of insulin, addressing patients' psychosocial barriers and quality of life concerns, understanding pharmacokinetic properties of insulin formulations, selecting appropriate therapy and patient-based regimens, and intensifying therapy to achieve glycemic control.
Diabetes education, including intentional curriculum design, for patients with T2DM who are initiating or intensifying insulin therapy, addresses patient barriers to care, reduces the burden of treatment, improves adherence to treatment protocols, and helps optimize clinical outcomes.
现有证据表明，在 2 型糖尿病（T2DM）中尽早开始胰岛素治疗可改善血糖控制、对后续口服抗糖尿病药物的反应性、β细胞功能和可能的心血管结局。美国糖尿病协会（ADA）/欧洲糖尿病研究协会（EASD）2008 年的算法在 T2DM 的治疗中更早地引入了胰岛素治疗，并迅速加强治疗以达到治疗目标。药物选择和胰岛素方案基于患者的 A1C 水平和监测血糖、使用以前药物、血糖模式、饮食和生活方式的意愿。为糖尿病教育者和临床医生提供的实际考虑因素包括制定早期开始胰岛素治疗的策略、解决患者的心理社会障碍和生活质量问题、了解胰岛素制剂的药代动力学特性、选择适当的治疗和基于患者的方案以及加强治疗以实现血糖控制。
对开始或加强胰岛素治疗的 T2DM 患者进行糖尿病教育，包括有针对性的课程设计，可以解决患者的护理障碍，减轻治疗负担，提高治疗方案的依从性，并有助于优化临床结局。
