Department of Medicine, University of Florida College of Medicine, Jacksonville, USA.
Drugs Aging. 2011 Jun 1;28(6):429-38. doi: 10.2165/11590570-000000000-00000.
Aging is associated with alterations in insulin secretion and action. However, aging per se does not alter the pharmacokinetics of commercially available insulin and its analogues. Insulin therapy in older adults is complicated by psychosocial and physiological changes of aging. Several new insulin and insulin analogue preparations are now available for clinical use. Used as prandial (e.g. insulin lispro, insulin aspart or insulin glulisine) and basal insulin (e.g. insulin glargine, insulin detemir), these analogues simulate physiological insulin profiles more closely than the older conventional insulins. The availability of multiple insulin products provides new opportunities to achieve control of diabetes mellitus. The choice of initial insulin therapy can be made based on blood glucose profiles. Overall, these profiles can be divided into three general patterns that include: (i) round-the-clock hyperglycaemia; (ii) fasting hyperglycaemia with daytime euglycaemia; and (iii) daytime hyperglycaemia with normal fasting blood glucose levels. The prescription of insulin is a dynamic process, and the insulin regimen should be adjusted based on individual response. The goal of diabetes care in older adults is to enhance quality of life without subjecting individuals to complicated treatment regimens that may interfere with their independence in carrying out daily activities.
衰老是与胰岛素分泌和作用的改变有关。然而，衰老本身并不会改变市售胰岛素及其类似物的药代动力学。老年人的胰岛素治疗受到衰老的心理社会和生理变化的影响。目前有几种新的胰岛素和胰岛素类似物制剂可供临床使用。这些类似物可作为餐时（如胰岛素赖脯、胰岛素门冬或胰岛素谷赖）和基础胰岛素（如甘精胰岛素、地特胰岛素）使用，与较老的常规胰岛素相比，它们更能模拟生理胰岛素谱。多种胰岛素产品的出现为控制糖尿病提供了新的机会。初始胰岛素治疗的选择可以根据血糖谱来进行。总的来说，这些图谱可以分为三种一般模式，包括：（i）全天高血糖；（ii）白天血糖正常但空腹高血糖；和（iii）白天高血糖但空腹血糖水平正常。胰岛素的处方是一个动态的过程，应根据个体反应调整胰岛素方案。老年人糖尿病治疗的目标是提高生活质量，而不会使个体承受可能干扰其进行日常活动独立性的复杂治疗方案。
