Rodacki M, Carvalho R M, Zajdenverg L
Universidade Federal do Rio de Janeiro, Medical Clinic Department, Nutrology and Diabetes Unit, Brazil.
Endocrinologist at Private Office, Brazil.
Diabetes Res Clin Pract. 2017 Nov;133:92-103. doi: 10.1016/j.diabres.2017.06.003. Epub 2017 Jun 30.
Despite the therapeutic advances in the treatment of diabetes, metabolic control instability due to glycemic variability (GV) is frequently observed in patients with diabetes on intensive insulin therapy and is associated with hyperglycemic peaks and hypoglycemic episodes. Hyperglycemia associated with GV has been implicated in the development of chronic complications due to its pro-oxidative consequences. On the other hand, hypoglycemia can be associated with increased cardiovascular risk secondarily to adrenergic activation. The ultra-long-acting insulin analogue, insulin degludec (IDeg), presents a flat and stable glucose-lowering effect both in Type 1 and Type 2 diabetes patients. In pharmacodynamic studies, IDeg has been associated with a lower variability in its insulin action than other alternatives for basal insulin, which might have clinical advantages for the stability of the glycemic control. The main objective of this review is to present pharmacological and clinical data regarding the efficacy and safety of IDeg for the treatment of diabetes focusing on its effects on GV and on hypoglycemia frequency.
尽管在糖尿病治疗方面取得了治疗进展，但在接受强化胰岛素治疗的糖尿病患者中，经常观察到由于血糖变异性（GV）导致的代谢控制不稳定，这与高血糖峰值和低血糖发作有关。与GV相关的高血糖因其促氧化后果而与慢性并发症的发生有关。另一方面，低血糖可能继发于肾上腺素能激活而增加心血管风险。超长效胰岛素类似物德谷胰岛素（IDeg）在1型和2型糖尿病患者中均呈现出平稳且稳定的降糖效果。在药效学研究中，与其他基础胰岛素替代品相比，IDeg的胰岛素作用变异性更低，这可能对血糖控制的稳定性具有临床优势。本综述的主要目的是介绍有关IDeg治疗糖尿病的疗效和安全性的药理学和临床数据，重点关注其对GV和低血糖发生频率的影响。
