Department of Endocrinology, The Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
J Diabetes. 2013 Sep;5(3):268-74. doi: 10.1111/1753-0407.12054. Epub 2013 May 29.
Type 2 diabetes mellitus (T2DM) is a progressive disease characterized by worsening insulin resistance and a decline in β-cell function. Achieving good glycemic control becomes more challenging as β-cell function continues to deteriorate throughout the disease process. The traditional management paradigm emphasizes a stepwise approach, and insulin has generally been reserved as a final armament. However, mounting evidence indicates that short-term intensive insulin therapy used in the early stages of type 2 diabetes could improve β-cell function, resulting in better glucose control and more extended glycemic remission than oral antidiabetic agents. Improvements in insulin sensitivity and lipid profile were also seen after the early initiation of short-term intensive insulin therapy. Thus, administering short-term intensive insulin therapy to patients with newly diagnosed T2DM has the potential to delay the natural process of this disease, and should be considered when clinicians initiate treatment. Although the early use of insulin is advocated by some guidelines, the optimal time to initiate insulin therapy is not clearly defined or easily recognized, and a pragmatic approach is lacking. Herein we summarize the current understanding of early intensive insulin therapy in patients with newly diagnosed T2DM, focusing on its clinical benefit and problems, as well as possible biological mechanisms of action, and discuss our perspective.
2 型糖尿病（T2DM）是一种进展性疾病，其特征为胰岛素抵抗逐渐加重和β细胞功能逐渐下降。随着疾病进程中β细胞功能持续恶化，实现良好的血糖控制变得更加具有挑战性。传统的管理模式强调逐步递进的方法，胰岛素通常被保留作为最后的手段。然而，越来越多的证据表明，在 2 型糖尿病的早期使用短期强化胰岛素治疗可以改善β细胞功能，与口服抗糖尿病药物相比，可实现更好的血糖控制和更长时间的血糖缓解。短期强化胰岛素治疗早期还可改善胰岛素敏感性和血脂谱。因此，对新诊断的 T2DM 患者进行短期强化胰岛素治疗有可能延缓该疾病的自然进程，在临床医生开始治疗时应予以考虑。尽管一些指南提倡早期使用胰岛素，但胰岛素治疗的最佳起始时间尚未明确界定或易于识别，并且缺乏实用的方法。本文总结了新诊断 T2DM 患者短期强化胰岛素治疗的现有认识，重点讨论其临床获益和问题，以及可能的作用生物学机制，并探讨了我们的观点。
