Section of Endocrinology, Tulane University Health Sciences Center, Tulane University School of Medicine, 1430 Tulane Avenue, SL 53, New Orleans, LA 70112, USA.
Nat Rev Endocrinol. 2014 May;10(5):276-81. doi: 10.1038/nrendo.2014.17. Epub 2014 Feb 18.
Insulin therapy is an effective method for reducing blood glucose levels in patients with type 2 diabetes mellitus (T2DM), and most patients with T2DM eventually require insulin replacement to attain and preserve satisfactory glycaemic control. All patients with T2DM should be considered as potential candidates for intensive insulin treatment; however, there are certain considerations regarding replacement therapy for different types of people and special populations, such as patients with multiple comorbidities, adolescents, pregnant women and the elderly. Lowering HbA1c levels in isolation without assessing the patient as a whole is becoming redundant. HbA1c targets should be individualized to the specific patient, and insulin treatment ought to be customized accordingly. There are several questions that need to be taken into account when considering adding insulin therapy to other oral antidiabetic agents, for example, for whom and when insulin therapy is indicated and which basal insulin should be utilized. Potential barriers exist related to patients, providers and health-care systems that can delay the start of insulin therapy, and every effort should be made to identify and address these obstacles.
胰岛素治疗是降低 2 型糖尿病（T2DM）患者血糖水平的有效方法，大多数 T2DM 患者最终需要胰岛素替代治疗以达到并维持满意的血糖控制。所有 T2DM 患者均应被视为强化胰岛素治疗的潜在候选者；然而，对于不同类型的人群和特殊人群，如合并多种疾病的患者、青少年、孕妇和老年人，在考虑替代治疗时需要考虑一些因素。单纯降低 HbA1c 水平而不全面评估患者已变得多余。HbA1c 目标应针对特定患者个体化，胰岛素治疗也应相应定制。在考虑将胰岛素治疗添加到其他口服降糖药物中时，需要考虑几个问题，例如，何时以及为何需要胰岛素治疗，以及应该使用哪种基础胰岛素。与患者、医务人员和医疗保健系统相关的潜在障碍可能会延迟胰岛素治疗的开始，应尽一切努力识别和解决这些障碍。
