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2 型糖尿病患者的医源性低血糖:胰岛素类似物预混和人胰岛素预混的比较。

Iatrogenic hypoglycemia in patients with type 2 diabetes: comparison of insulin analog premixes and human insulin premixes.

机构信息

New York-Presbyterian/Weill Cornell Medical Center, Manhattan Endocrinology, PLLC, New York, NY 10065, USA.

出版信息

Postgrad Med. 2011 Jul;123(4):7-16. doi: 10.3810/pgm.2011.07.2299.

Abstract

Severe iatrogenic--or therapy-induced--hypoglycemia has been associated with mortality rates as high as 10% in patients with type 2 diabetes mellitus (T2DM), and is therefore one of the most significant barriers to glucose management in this patient population. Therapy with modern insulin analogs has been shown to cause significantly less hypoglycemic episodes than human insulins in basal-bolus regimens. This systematic review examines whether a similar benefit has been observed with the insulin analog premixes (aspart 70/30, lispro 75/25, or lispro 50/50) relative to human insulin premix (human 70/30). Consistent with a prior meta-analysis, the results presented here reconfirm that overall hypoglycemia risk is similar after treatment with either an analog premix or a human premix in many populations of patients with T2DM. However, several studies found a benefit for the analog premixes in a subset of patients who were under more challenging glucometabolic conditions, in particular those later in disease progression or those undergoing post-injection exercise. Pharmacokinetic and pharmacodynamic studies indicate that this may occur because a larger proportion of total analog premix activity is absorbed and utilized during the immediate postprandial period, when it is most acutely needed, compared with human premixes. Consequently, with analog premixes, less insulin activity is available during the inter-meal fasting period, when hypoglycemia is most likely to occur. Given the clinical significance of iatrogenic hypoglycemia, these potential hypoglycemic benefits of analog premixes relative to human premixes in some patients with T2DM may need to be factored into the therapeutic decision-making process.

摘要

严重的医源性——或治疗引起的——低血糖与 2 型糖尿病(T2DM)患者高达 10%的死亡率相关,因此是该患者人群葡萄糖管理的最大障碍之一。与基础-餐时方案中的人胰岛素相比,现代胰岛素类似物的治疗已被证明可显著减少低血糖发作。本系统评价检查了胰岛素类似物预混剂(门冬氨酸 70/30、赖脯氨酸 75/25 或赖脯氨酸 50/50)相对于人胰岛素预混剂(人 70/30)是否观察到类似的益处。与先前的荟萃分析一致,这里呈现的结果再次证实,在许多 T2DM 患者人群中,使用类似物预混剂或人预混剂治疗后,总体低血糖风险相似。然而,一些研究发现,在一些面临更具挑战性的糖代谢条件的患者亚组中,类似物预混剂具有优势,特别是那些疾病进展后期或注射后运动的患者。药代动力学和药效学研究表明,这可能是因为与人预混剂相比,更多的总类似物预混剂活性在餐后立即吸收和利用,而此时最急需。因此,与人预混剂相比,在餐间空腹期间,类似物预混剂的胰岛素活性较少,此时最有可能发生低血糖。鉴于医源性低血糖的临床意义,在一些 T2DM 患者中,类似物预混剂相对于人预混剂的这些潜在低血糖益处可能需要纳入治疗决策过程。

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