Division of Endocrinology, Metabolism, and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
JAMA. 2014 Jun 11;311(22):2315-25. doi: 10.1001/jama.2014.5951.
The incidence and prevalence of type 2 diabetes mellitus are increasing.
To review currently available insulin therapy, as well as evidence on the use, application, initiation, and intensification of insulin in the outpatient setting.
Data sources included PubMed for trials and investigations in type 2 diabetes examining insulin use from January 1998 to April 2014.
The hemoglobin A1c target for most patients with type 2 diabetes is 7% but needs to be modified when there is increased risk of hypoglycemia, reduced life expectancy, extensive comorbidities, or reduced resources. Insulin therapy may be considered early or late in the disease course; adverse effects include weight gain and hypoglycemia. Basal insulin can be added to oral hypoglycemic agents (generally stopping sulfonylureas) initially, and later, prandial insulin can be added in a stepwise fashion. Insulin treatment must be individualized, and there are a number of challenges to insulin initiation and intensification.
Insulin can help achieve ideal hemoglobin A1c goals for patients with type 2 diabetes. Barriers such as adherence, patient preferences, clinician preferences, and resource allocation must be addressed.
2 型糖尿病的发病率和患病率正在上升。
综述目前可用的胰岛素治疗方法，以及关于在门诊环境中使用、应用、起始和强化胰岛素的证据。
数据来源包括 PubMed，检索了 1998 年 1 月至 2014 年 4 月期间有关 2 型糖尿病胰岛素使用的试验和研究。
大多数 2 型糖尿病患者的血红蛋白 A1c 目标值为 7%，但当存在低血糖风险增加、预期寿命缩短、广泛合并症或资源减少时，需要进行调整。胰岛素治疗可以在疾病早期或晚期开始；不良反应包括体重增加和低血糖。最初可以在口服降糖药的基础上添加基础胰岛素（通常停止使用磺酰脲类药物），然后可以逐步添加餐时胰岛素。胰岛素治疗必须个体化，在起始和强化胰岛素治疗方面存在诸多挑战。
胰岛素可以帮助 2 型糖尿病患者实现理想的血红蛋白 A1c 目标。必须解决依从性、患者偏好、临床医生偏好和资源分配等障碍。
