现代胰岛素、旧有模式与实用主义：在决定如何治疗1型糖尿病时做出明智选择。
Modern insulins, old paradigms and pragmatism: choosing wisely when deciding how to treat type 1 diabetes.
作者信息
Schaan Beatriz D, Scheffel Rafael Selbach
机构信息
Endocrine Division, Hospital de Clínicas de Porto Alegre and Medical Faculty, Universidade Federal do Rio Grande do Sul, Rua Ramiro Barcelos 2350, prédio 12, 4° andar, Porto Alegre, RS 90035-003 Brazil.
Internal Medicine Division, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
出版信息
Diabetol Metab Syndr. 2015 Apr 22;7:35. doi: 10.1186/s13098-015-0033-4. eCollection 2015.
There is a clinical imperative to improve metabolic control in the treatment of patients with type 1 diabetes, but in doing so, hypoglycemia should be avoided at all costs. Insulin analogues and the assumption they would better mimic the pharmacokinetic profile of endogenous insulin secretion emerged as a magic bullet in the treatment of patients with type 1 diabetes. However, although insulin analogues have pharmaceutical properties, such as pharmacodynamic stability, reproducibility of action, and a more physiological timing of action, which could possibly facilitate insulin use, the results obtained in clinical practice have not been as good as expected. Like all clinical decisions, the decision regarding which insulin would be better for the patient should be, if possible, evidence based. Here, we briefly discuss evidence for the use of insulin analogues and the different views with respect to the available evidence that lead to different interpretations and decisions regarding the use of this new technology.
在1型糖尿病患者的治疗中，改善代谢控制具有临床紧迫性，但在这样做的过程中，应不惜一切代价避免低血糖。胰岛素类似物以及它们能更好地模拟内源性胰岛素分泌的药代动力学特征这一假设，成为了治疗1型糖尿病患者的神奇疗法。然而，尽管胰岛素类似物具有药物特性，如药效学稳定性、作用的可重复性以及更符合生理的作用时间，这可能会促进胰岛素的使用，但临床实践中获得的结果却不如预期。与所有临床决策一样，如果可能的话，关于哪种胰岛素对患者更好的决策应该基于证据。在此，我们简要讨论使用胰岛素类似物的证据，以及关于现有证据的不同观点，这些观点导致了对这项新技术使用的不同解释和决策。
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