Joslin Diabetes Center, Harvard School of Medicine, Boston, MA 02215, USA.
Ann Med. 2012 Dec;44(8):836-46. doi: 10.3109/07853890.2012.699715. Epub 2012 Jul 23.
The incidence of diabetes mellitus is projected to continue to increase worldwide over the next 20 years leading to increased costs in the management of the disease and its associated co-morbidities. Insulin replacement is one of many treatment options that can help to bring about near normoglycemia in the patient with type 2 diabetes mellitus (T2DM). Glycemic control as close to normoglycemia as possible can help to reduce the risk of microvascular and macrovascular complications, yet less than one-half of patients with T2DM achieve glycemic targets as recommended by practice guidelines. The purpose of this review is to provide guidance to primary care physicians for the initiation and intensification of basal-bolus insulin therapy in patients with T2DM. Two treatment algorithms that can be both patient- and physician-driven are proposed: a stepwise approach and a multiple daily injections approach. Evidence shaping the two approaches will be discussed alongside management issues that surround the patient treated with insulin: hypoglycemia, weight gain, patient education, and quality of life.
在未来 20 年内，全球范围内糖尿病的发病率预计将继续上升，导致疾病管理和相关合并症的成本增加。胰岛素替代是许多治疗选择之一，可帮助 2 型糖尿病（T2DM）患者实现接近正常血糖水平。尽可能接近正常血糖水平的血糖控制有助于降低微血管和大血管并发症的风险，但 T2DM 患者中只有不到一半的人达到了实践指南推荐的血糖目标。本综述的目的是为初级保健医生提供指导，以启动和强化 T2DM 患者的基础-餐时胰岛素治疗。提出了两种既可以患者驱动也可以医生驱动的治疗方案：逐步方案和多次每日注射方案。将讨论形成两种方法的证据，以及围绕接受胰岛素治疗的患者的管理问题：低血糖、体重增加、患者教育和生活质量。
