Helena W Rodbard, Karolicki Boris
Medical Director, Endocrine and Metabolic Consultants, Rockville, Maryland, US.
Medical Director, Novo Nordisk Inc., Princeton, New Jersey, US.
Eur Endocrinol. 2014 Aug;10(2):124-130. doi: 10.17925/EE.2014.10.02.124. Epub 2014 Aug 25.
As glycaemic control deteriorates with the progression of type 2 diabetes, treatment guidelines advocate starting basal insulin therapy, and then progressing to a basal-bolus regimen as needed. Nevertheless, although timely intensification of therapy is important to minimise the risk of diabetic complications, considerable clinical inertia exists, not only in the initiation of insulin but also in the progression to multiple-dose insulin regimens. One barrier has been the lack of guidance about how to make the transition from basal-only to basal-bolus insulin therapy. In this review, we discuss how data from the recent FullSTEP study, along with other randomised studies, will help to bridge this gap. Prandial boluses can be added to basal insulin in a stepwise manner, using a straightforward, patient-led dose titration approach and simple estimation of which meal to add the initial prandial bolus to. Reducing the complexity of progression to multiple-dose insulin regimens and empowering patients will lessen the burden on clinicians, improve treatment satisfaction and facilitate timely implementation of treatment guidelines.
随着2型糖尿病病情进展，血糖控制恶化，治疗指南提倡开始基础胰岛素治疗，然后根据需要进展为基础-餐时胰岛素方案。然而，尽管及时强化治疗对于将糖尿病并发症风险降至最低很重要，但临床上存在相当大的惰性，不仅在胰岛素起始治疗方面，而且在进展为多次注射胰岛素方案方面。一个障碍是缺乏关于如何从仅使用基础胰岛素过渡到基础-餐时胰岛素治疗的指导。在本综述中，我们讨论了近期FullSTEP研究的数据以及其他随机研究将如何有助于弥合这一差距。可以采用一种直接的、患者主导的剂量滴定方法，并简单估计将初始餐时大剂量胰岛素添加到哪一餐，以逐步方式将餐时大剂量胰岛素添加到基础胰岛素中。降低进展为多次注射胰岛素方案的复杂性并赋予患者权力，将减轻临床医生的负担，提高治疗满意度，并促进治疗指南的及时实施。
