Lovre Dragana, Fonseca Vivian
Tulane University Health Sciences Center, New Orleans, LA.
Tulane University Health Sciences Center, New Orleans, LA.
J Diabetes Complications. 2015 Mar;29(2):295-301. doi: 10.1016/j.jdiacomp.2014.11.018. Epub 2014 Dec 5.
Worldwide, both underdiagnosis and undertreatment leave many patients exposed to long periods of hyperglycemia and contribute to irreversible diabetes complications. Early glucose control reduces the risk of both macrovascular and microvascular complications, while tight control late in diabetes has little or no macrovascular benefit. Insulin therapy offers the most potent antihyperglycemic effect of all diabetes agents, and has a unique ability to induce diabetes remission when used to normalize glycemia in newly diagnosed patients. When used as a second-line therapy, basal insulin is more likely to safely and durably maintain A1C levels ≤7% than when insulin treatment is delayed. The use of basal insulin analogs is associated with a reduced risk of hypoglycemia and weight gain compared to NPH insulin and pre-mixed insulin. Patient self-titration algorithms can improve glucose control while decreasing the burden on office staff. Finally, recent data suggest that addition of incretin agents to basal insulin may improve glycemic control with very little, if any increased risk of hypoglycemia or weight gain.
在全球范围内，诊断不足和治疗不足使许多患者长期处于高血糖状态，并导致不可逆的糖尿病并发症。早期血糖控制可降低大血管和微血管并发症的风险，而糖尿病晚期的严格控制对大血管几乎没有益处。胰岛素治疗在所有糖尿病药物中具有最强的降糖作用，并且在用于使新诊断患者的血糖正常化时具有诱导糖尿病缓解的独特能力。当作为二线治疗使用时，与延迟胰岛素治疗相比，基础胰岛素更有可能安全、持久地将糖化血红蛋白（A1C）水平维持在≤7%。与中性鱼精蛋白锌胰岛素（NPH胰岛素）和预混胰岛素相比，使用基础胰岛素类似物可降低低血糖和体重增加的风险。患者自我滴定算法可改善血糖控制，同时减轻办公室工作人员的负担。最后，最近的数据表明，在基础胰岛素中添加肠促胰岛素药物可能改善血糖控制，且低血糖或体重增加风险即使有增加也非常小。
