Diabetes Reference Unit, Endocrinology and Nutrition Department, Clinic University Hospital of Valencia, Valencia, Spain.
Diabetes Technol Ther. 2011 Jun;13 Suppl 1:S75-83. doi: 10.1089/dia.2011.0001.
Type 2 diabetes is characterized by insulin resistance and progressive β-cell deterioration. As β-cell function declines, most patients with type 2 diabetes treated with oral agents, in monotherapy or combination, will require insulin therapy. Addition of basal insulin (glargine, detemir, or NPH/neutral protamine lispro insulin) to previous treatment is accepted as the simplest way to start insulin therapy in those patients. But even when basal insulin is adequately titrated, some patients will also need prandial insulin to achieve or maintain individual glycemic targets over time. Starting with premixed insulin is an effective option, but it is frequently associated with increased hypoglycemia risk, fixed meal schedules, and weight gain. As an alternative, a novel approached known as "basal plus strategy" has been developed. This approach considers the addition of increasing injections of prandial insulin, beginning with the meal that has the major impact on postprandial glucose values. Finally, if this is not enough intensification to basal-bolus will be necessary. In reducing hyperglycemia, this modality still remains the most effective option, even in people with type 2 diabetes. This article will review the currently evidence on the basal plus strategy and also its progression to basal-bolus therapy. In addition, practical recommendations to start and adjust basal plus therapy will be provided.
2 型糖尿病的特征为胰岛素抵抗和进行性β细胞功能恶化。随着β细胞功能下降，大多数接受口服药物单药或联合治疗的 2 型糖尿病患者将需要胰岛素治疗。在之前的治疗基础上添加基础胰岛素（甘精胰岛素、地特胰岛素或 NPH/中性鱼精蛋白赖脯胰岛素）被认为是此类患者开始胰岛素治疗的最简单方法。但即使基础胰岛素得到充分滴定，一些患者仍需要餐时胰岛素以实现或维持随时间推移的个体血糖目标。起始预混胰岛素是一种有效的选择，但它常与增加低血糖风险、固定进餐时间和体重增加相关。作为替代方案，开发了一种新的“基础加餐策略”。这种方法考虑了添加餐时胰岛素，起始于对餐后血糖值影响最大的那一餐。最后，如果这还不足以强化治疗，就需要转为基础-餐时胰岛素方案。在降低高血糖方面，这种方案仍然是最有效的选择，即使是 2 型糖尿病患者也是如此。本文将回顾基础加餐策略的现有证据，并探讨其向基础-餐时胰岛素方案的进展。此外，还将提供起始和调整基础加餐治疗的实用建议。
