Baker IDI Heart and Diabetes Institute, Melbourne, VIC, Australia.
Med J Aust. 2013 Aug 19;199(4):246-9. doi: 10.5694/mja12.11856.
• Type 2 diabetes mellitus (T2DM) is progressive; the more intensively it is treated, the greater is the risk of hypoglycaemia and weight gain. Achieving treatment intensification while mitigating these risks presents a challenge to patient management. • Basal insulins provide control of fasting glucose; however, their utility in the control of postprandial glucose excursions is limited. • Glucagon-like peptide-1 (GLP-1) receptor agonists stimulate glucose-medicated insulin secretion, suppress glucagon secretion, delay gastric emptying and decrease appetite. Use of GLP-1 receptor agonists in combination therapy with basal insulin offers an alternative approach to intensification of insulin therapy. • Prospective interventional trials demonstrate that GLP-1 receptor agonists added to basal insulin decrease postprandial glucose levels, lower HbA1c levels, decrease weight and lower basal insulin requirements without increasing the risk of major hypoglycaemic events. • The current clinical data are limited by the lack of any data on the long-term effects of GLP-1 receptor agonists over additional prandial regimens; they may be beneficial or deleterious. • Although cost, gastrointestinal side effects and long-term safety should be taken into account when considering this combination, it appears to be growing in popularity and is likely to be an important therapeutic option for T2DM in the future.
• 2 型糖尿病（T2DM）是进行性的；治疗越强化，低血糖和体重增加的风险就越大。在强化治疗的同时降低这些风险，这对患者管理提出了挑战。
• 基础胰岛素可控制空腹血糖；然而，其控制餐后血糖波动的效果有限。
• 胰高血糖素样肽-1（GLP-1）受体激动剂可刺激葡萄糖介导的胰岛素分泌，抑制胰高血糖素分泌，延缓胃排空并降低食欲。将 GLP-1 受体激动剂与基础胰岛素联合用于联合治疗，为强化胰岛素治疗提供了另一种选择。
• 前瞻性干预性试验表明，GLP-1 受体激动剂联合基础胰岛素可降低餐后血糖水平，降低 HbA1c 水平，减轻体重并降低基础胰岛素需求，而不会增加严重低血糖事件的风险。
• 目前的临床数据受到限制，因为缺乏关于 GLP-1 受体激动剂对额外进餐方案的长期影响的数据；它们可能有益或有害。
• 尽管在考虑这种联合治疗时应考虑成本、胃肠道副作用和长期安全性，但它似乎越来越受欢迎，并且可能是未来 T2DM 的重要治疗选择。
