Department of Medicine, Division of Diabetes, Endocrinology and Metabolism, Vanderbilt University School of Medicine, Nashville, TN 37232-0475, USA.
Postgrad Med. 2011 Jul;123(4):17-26. doi: 10.3810/pgm.2011.07.2300.
Primary goals in the treatment of type 2 diabetes mellitus (T2DM) include lowering blood glucose levels sufficiently to prevent micro- and macrovascular complications while limiting side effects, such as hypoglycemia and excessive weight gain. Patients with T2DM are typically treated initially with oral antidiabetes agents; however, as the disease progresses, most will require insulin to maintain glycemic control. Often insulin therapy is initiated with basal insulin, and the objective of this article is to present the conceptual aspects of basal insulin therapy and use these concepts to illustrate important clinical aspects. This will be accomplished within a broader contextual discussion of the normal physiologic patterns of insulin secretion, which consist of sustained levels of basal insulin production throughout the day, superimposed with bursts of insulin secretion following a meal (termed bolus or prandial insulin secretion) that slowly decay over 1 to 3 hours. Long-acting basal insulin analogs form a key component of basal-bolus therapy and provide basal support for patients with T2DM. Insulin therapy is often initiated with basal insulin, and newer long-acting analogs, such as insulin glargine and insulin detemir, provide steady, reliable basal insulin coverage in addition to significant advantages over traditional long-acting insulins. This article will integrate conceptual aspects of basal insulin therapy in the context of physiology, molecular pharmacology, and clinical implications of modern basal insulin analogs to provide a foundational understanding of basal insulin biology and physiology.
治疗 2 型糖尿病（T2DM）的主要目标包括降低血糖水平，以充分预防微血管和大血管并发症，同时限制低血糖和体重过度增加等副作用。T2DM 患者通常最初采用口服抗糖尿病药物治疗；然而，随着疾病的进展，大多数患者将需要胰岛素来维持血糖控制。通常，胰岛素治疗是从基础胰岛素开始的，本文的目的是介绍基础胰岛素治疗的概念方面，并利用这些概念来阐述重要的临床方面。这将在更广泛的胰岛素分泌正常生理模式的讨论背景下完成，这些模式包括全天持续的基础胰岛素生成水平，以及餐后胰岛素分泌的爆发（称为餐时或进食相关胰岛素分泌），这些爆发在 1 至 3 小时内逐渐消退。长效基础胰岛素类似物是基础-餐时治疗的重要组成部分，为 T2DM 患者提供基础支持。胰岛素治疗通常从基础胰岛素开始，新型长效类似物，如甘精胰岛素和地特胰岛素，除了在传统长效胰岛素方面具有显著优势外，还能提供稳定、可靠的基础胰岛素覆盖。本文将在生理学、分子药理学和现代基础胰岛素类似物的临床意义的背景下整合基础胰岛素治疗的概念方面，提供对基础胰岛素生物学和生理学的基本理解。
