Shaefer Charles F, Anderson John
a University Medical Associates - Primary Care, University Health Systems , Augusta , GA , USA.
b Frist Clinic , Nashville , TN , USA.
Postgrad Med. 2016 Jan;128(1):137-44. doi: 10.1080/00325481.2016.1103640. Epub 2015 Nov 7.
Diabetes, mainly type 2 diabetes mellitus (T2DM), is associated with a growing clinical and economic burden in the United States, which is expected to increase in association with an aging population. Sufficient glycemic control in patients with T2DM, in order to reduce the risk of micro- and macrovascular complications associated with diabetes, is mediated by lifestyle modifications and a regimen of increasingly intensive antidiabetes drugs. Several treatments and strategies are available for primary care physicians to select from when choosing the most appropriate therapy for their individual patients with T2DM, but, ultimately, due to the progressive nature of the disease, most of these patients will require insulin therapy to maintain glycemic control. Regimens containing basal and postprandial insulins are widely used, but there is still widespread reluctance to initiate insulin treatment due to fear of weight gain and hypoglycemia. Furthermore, as patients approach recommended glycated hemoglobin targets, postprandial hyperglycemia becomes the main contributor to hyperglycemic exposure, necessitating the timely initiation of prandial treatment. Finally, insulin treatment can be limited by factors like the number of injections, mealtime restrictions, complex titration algorithms and patient adherence. Recent developments in antidiabetes drug research have brought more convenient basal and postprandial regimens closer. Clinical evaluation of the efficacy and safety of basal insulins plus add-on glucagon-like peptide-1 receptor agonists (GLP-1 RAs) has yielded promising results. Primary care physicians are continually challenged to optimize insulin treatment strategies to maximize patient outcomes. Emerging strategies such as long-acting basal insulin analogs and short-acting GLP-1 RAs are particularly appealing to address this challenge.
糖尿病，主要是2型糖尿病（T2DM），在美国带来了日益沉重的临床和经济负担，预计随着人口老龄化，这一负担还会增加。为降低与糖尿病相关的微血管和大血管并发症风险，T2DM患者的充分血糖控制通过生活方式改变和日益强化的抗糖尿病药物治疗方案来实现。对于基层医疗医生而言，在为个体T2DM患者选择最合适的治疗方法时有多种治疗手段和策略可供选择，但最终，由于该疾病的进展性，大多数这些患者将需要胰岛素治疗来维持血糖控制。包含基础胰岛素和餐时胰岛素的治疗方案被广泛使用，但由于担心体重增加和低血糖，人们对启动胰岛素治疗仍普遍存在抵触情绪。此外，随着患者接近推荐的糖化血红蛋白目标，餐后高血糖成为高血糖暴露的主要因素，因此需要及时启动餐时治疗。最后，胰岛素治疗可能会受到注射次数、进餐时间限制、复杂的滴定算法和患者依从性等因素的限制。抗糖尿病药物研究的最新进展使更方便的基础胰岛素和餐时胰岛素治疗方案更近一步。基础胰岛素加胰高血糖素样肽-1受体激动剂（GLP-1 RAs）的疗效和安全性的临床评估已产生了令人鼓舞的结果。基层医疗医生不断面临优化胰岛素治疗策略以实现最佳患者治疗效果的挑战。长效基础胰岛素类似物和短效GLP-1 RAs等新兴策略对于应对这一挑战尤其具有吸引力。
