Maria Rotella Carlo, Pala Laura, Mannucci Edoardo
Obesity Agency, University of Florence Medical School, Careggi Teaching Hospital, Firenze, Italy.
Endocrinolgy Unit , University of Florence Medical School, Careggi Teaching Hospital, Firenze, Italy.
Int J Endocrinol Metab. 2013 Summer;11(3):137-44. doi: 10.5812/ijem.7551. Epub 2013 Jul 1.
Since 2006 a relevant number of therapeutical algorithms for the management of type 2 diabetes have been proposed, generating a lively debate in the scientific community, particularly on the ideal timing for introduction of insulin therapy and on which drug should be preferred as add-on therapy in patients failing to metformin. At the moment, there is no real consensus. The aim of the present review is to summarize established knowledge and areas for debate with respect to insulin therapy in type 2 diabetes.
In type 2 diabetic patients, insulin represents a therapy with a long and well-established history, but, considering the modern insulin therapy, several points must be carefully examined. The role played by the introduction of insulin analogues, the choice of insulin regimens, the ongoing debate on insulin and cancer, the cardiovascular effects of insulin, the role of insulin on β-cell protection and the actual clinical perspective in the treatment of the disease. Nevertheless, still many exciting expectations exist: the new insulin analogues, the technological options, the inhaled and oral insulin and the issue of transplantation.
Although insulin is the more potent hypoglicemic agent, the availability of a wider spectrum of therapeutic agents, many of which are better tolerated than insulin, has reduced the field of application for insulin treatment; presently, insulin is used only in those who cannot maintain an adequate glycemic control with other drugs. Furthermore, a lively research activity is currently ongoing, in order to make insulin therapy even safer and simpler for patients.
自2006年以来，已经提出了相当数量的2型糖尿病治疗算法，在科学界引发了热烈的讨论，特别是关于胰岛素治疗开始的理想时机以及在二甲双胍治疗失败的患者中应首选哪种药物作为附加治疗。目前，尚无真正的共识。本综述的目的是总结2型糖尿病胰岛素治疗方面的既有知识和争议领域。
在2型糖尿病患者中，胰岛素是一种历史悠久且应用广泛的治疗方法，但就现代胰岛素治疗而言，有几个要点必须仔细审视。胰岛素类似物的引入所起的作用、胰岛素治疗方案的选择、关于胰岛素与癌症的持续争论、胰岛素的心血管效应、胰岛素对β细胞保护的作用以及该疾病治疗的实际临床前景。然而，仍有许多令人期待的方面：新型胰岛素类似物、技术选择、吸入式和口服胰岛素以及移植问题。
尽管胰岛素是最有效的降糖药物，但更多种类治疗药物的出现，其中许多药物的耐受性优于胰岛素，这缩小了胰岛素治疗的应用范围；目前，胰岛素仅用于那些无法通过其他药物维持充分血糖控制的患者。此外，目前正在进行积极的研究活动，以使胰岛素治疗对患者更安全、更简便。
