Diabetes Research, Hamburg, Germany.
Diabetes and Endocrinology, Royal Liverpool University Hospital, Liverpool, UK.
Diabet Med. 2018 Jun;35(6):694-706. doi: 10.1111/dme.13610. Epub 2018 Mar 24.
As Type 2 diabetes progresses, treatment is intensified with additional therapies in an effort to manage hyperglycaemia effectively and therefore avoid complications. When greater efficacy is required, options for injectable treatments include glucagon-like peptide-1 receptor agonists and insulin, which may be added on to oral glucose-lowering treatments. Among individuals receiving long-acting basal insulin as their first injectable treatment, ~40-60% are unable to achieve or maintain their target HbA goals. For these people, treatment intensification options are relatively limited and include the addition of short-acting prandial insulin or a glucagon-like peptide-1 receptor agonist. Glucagon-like peptide-1 receptor agonists vary in their effects, with short- and long-acting agents having a greater impact on postprandial and fasting hyperglycaemia, respectively. Studies comparing treatment intensification options have found both glucagon-like peptide-1 receptor agonists and prandial insulin to be effective in reducing HbA concentrations; however, recipients of glucagon-like peptide-1 receptor agonists lost weight and had a greater frequency of gastrointestinal adverse events, whereas those receiving prandial insulin gained weight and had a greater incidence of hypoglycaemia. In addition to the separate administration of a glucagon-like peptide-1 receptor agonist and basal insulin, fixed-ratio combinations of a glucagon-like peptide-1 receptor agonist and basal insulin offer a single administration for both treatments but have less flexibility in dose titration than treatment with their individual components. For individuals who require treatment intensification beyond basal insulin, use of these various options allows physicians to target the individual needs of their patients for the achievement of optimal long-term glycaemic control.
随着 2 型糖尿病的进展，会采用更多的治疗方法来强化治疗，以有效控制高血糖，从而避免并发症。当需要更大的疗效时，可选择注射用治疗药物，包括胰高血糖素样肽-1 受体激动剂和胰岛素，这些药物可与口服降糖药物联合使用。在接受长效基础胰岛素作为一线注射治疗的人群中，约有 40%-60%的人无法达到或维持其目标 HbA 水平。对于这些人，治疗强化的选择相对有限，包括添加短效餐时胰岛素或胰高血糖素样肽-1 受体激动剂。胰高血糖素样肽-1 受体激动剂的作用有所不同，短效和长效制剂分别对餐后和空腹高血糖有更大的影响。比较治疗强化选择的研究发现，胰高血糖素样肽-1 受体激动剂和餐时胰岛素均可有效降低 HbA 浓度；然而，接受胰高血糖素样肽-1 受体激动剂治疗的患者体重减轻，胃肠道不良反应发生率更高，而接受餐时胰岛素治疗的患者体重增加，低血糖发生率更高。除了分别给予胰高血糖素样肽-1 受体激动剂和基础胰岛素外，胰高血糖素样肽-1 受体激动剂与基础胰岛素的固定比例组合为两种治疗方法提供了单次给药，但剂量滴定的灵活性不如单独使用其成分。对于需要强化基础胰岛素治疗的患者，使用这些不同的选择可以使医生针对患者的个体需求，实现最佳的长期血糖控制。
