Iqbal Ahmed, Novodvorsky Peter, Heller Simon R
Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
Diabetes Metab J. 2018 Feb;42(1):3-18. doi: 10.4093/dmj.2018.42.1.3.
Type 1 diabetes mellitus (T1DM) is a chronic autoimmune condition that requires life-long administration of insulin. Optimal management of T1DM entails a good knowledge and understanding of this condition both by the physician and the patient. Recent introduction of novel insulin preparations, technological advances in insulin delivery and glucose monitoring, such as continuous subcutaneous insulin infusion (CSII) and continuous glucose monitoring and improved understanding of the detrimental effects of hypoglycaemia and hyperglycaemia offer new opportunities and perspectives in T1DM management. Evidence from clinical trials suggests an important role of structured patient education. Our efforts should be aimed at improved metabolic control with concomitant reduction of hypoglycaemia. Despite recent advances, these goals are not easy to achieve and can put significant pressure on people with T1DM. The approach of physicians should therefore be maximally supportive. In this review, we provide an overview of the recent advances in T1DM management focusing on novel insulin preparations, ways of insulin administration and glucose monitoring and the role of metformin or sodium-glucose co-transporter 2 inhibitors in T1DM management. We then discuss our current understanding of the effects of hypoglycaemia on human body and strategies aimed at mitigating the risks associated with hypoglycaemia.
1型糖尿病(T1DM)是一种慢性自身免疫性疾病,需要终身注射胰岛素。T1DM的最佳管理需要医生和患者对这种疾病有充分的了解。新型胰岛素制剂的近期推出、胰岛素给药和血糖监测方面的技术进步,如持续皮下胰岛素输注(CSII)和持续血糖监测,以及对低血糖和高血糖有害影响的更好理解,为T1DM的管理提供了新的机会和视角。临床试验证据表明结构化患者教育具有重要作用。我们的努力应旨在改善代谢控制,同时减少低血糖。尽管有近期的进展,但这些目标并不容易实现,可能会给T1DM患者带来巨大压力。因此,医生的方法应给予最大程度的支持。在本综述中,我们概述了T1DM管理的近期进展,重点关注新型胰岛素制剂、胰岛素给药方式和血糖监测,以及二甲双胍或钠-葡萄糖协同转运蛋白2抑制剂在T1DM管理中的作用。然后,我们讨论了目前对低血糖对人体影响的理解以及旨在降低低血糖相关风险的策略。