School of Pharmacy, Wingate University, NC 28174, USA.
Ann Pharmacother. 2010 Jul-Aug;44(7-8):1294-300. doi: 10.1345/aph.1P047. Epub 2010 Jun 8.
To evaluate the efficacy and tolerability of combination glucagon-like peptide-1 (GLP-1) analogs and insulin in the management of type 2 diabetes mellitus (T2DM) in adults.
A MEDLINE search (1966-April 2010) was conducted using the key terms glucagon-like peptide-1 analog, exenatide, incretin mimetic, liraglutide, diabetes mellitus, and insulin.
All English-language articles identified from the data source were evaluated and reviewed for inclusion. Original research and retrospective cohorts were included in this review. The references of articles that we identified were examined for any additional studies appropriate for review.
Exenatide is a subcutaneously administered GLP-1 receptor agonist that is used for the improvement of glycemic control in adults with T2DM. Through actions similar to those of endogenous GLP-1, exenatide contributes to improved postprandial glycemic control and weight loss. The concomitant use of exenatide and insulin is currently not Food and Drug Administration-approved due to lack of clinical trial data. However, combination insulin and exenatide may be advantageous, especially for reducing weight gain, particularly for obese patients with T2DM. Several small prospective and retrospective studies evaluating combination therapy found statistically significant reductions in hemoglobin A(1c) (A1C), weight, and total daily insulin dose requirements. The most common adverse effects reported included gastrointestinal effects, such as nausea and vomiting, and hypoglycemia.
Although there is a limited amount of data and not all studies demonstrated A1C reduction, the combination of exenatide with insulin therapy appears to be a safe option in the management of T2DM. It may be a promising therapeutic strategy for some patients, as reductions in weight and insulin doses were observed. Further well-designed prospective trials are warranted to fully determine the long-term effectiveness and safety of this combination as well as its place in therapy.
评估胰高血糖素样肽-1（GLP-1）类似物与胰岛素联合治疗成人 2 型糖尿病（T2DM）的疗效和耐受性。
使用关键词 GLP-1 类似物、艾塞那肽、肠降血糖素类似物、利拉鲁肽、糖尿病和胰岛素对 1966 年至 2010 年 4 月的 MEDLINE 进行了检索。
对从资料来源中确定的所有英文文章进行评估和审查，以确定是否符合入选标准。本综述纳入了原始研究和回顾性队列研究。还对我们确定的文章的参考文献进行了检查，以寻找其他适合审查的研究。
艾塞那肽是一种皮下给予的 GLP-1 受体激动剂，用于改善 T2DM 成人的血糖控制。通过与内源性 GLP-1 相似的作用，艾塞那肽有助于改善餐后血糖控制和体重减轻。由于缺乏临床试验数据，目前联合使用艾塞那肽和胰岛素尚未获得美国食品和药物管理局的批准。然而，联合胰岛素和艾塞那肽可能具有优势，特别是对于减少体重增加，特别是对于肥胖的 T2DM 患者。几项评估联合治疗的小型前瞻性和回顾性研究发现，血红蛋白 A1c（A1C）、体重和每日总胰岛素剂量需求均有统计学显著降低。报告的最常见不良反应包括胃肠道副作用，如恶心和呕吐，以及低血糖。
尽管数据有限，并非所有研究均显示 A1C 降低，但艾塞那肽与胰岛素联合治疗似乎是 T2DM 治疗的一种安全选择。对于一些患者来说，它可能是一种很有前途的治疗策略，因为观察到体重和胰岛素剂量的降低。需要进一步进行精心设计的前瞻性试验，以充分确定这种联合治疗的长期疗效和安全性及其在治疗中的地位。
