University of California San Diego Medical Center, San Diego, CA, United States.
Abington-Jefferson Urgent Care, Willow Grove, PA, United States.
Clin Ther. 2019 Feb;41(2):352-367. doi: 10.1016/j.clinthera.2018.11.015. Epub 2019 Jan 15.
Type 2 diabetes (T2D) is a progressive disease caused by insulin resistance and associated progressive β-cell functional decline, as well as multiple other related metabolic and pathophysiologic changes. Left unchecked, T2D increases the risk of long-term microvascular and cardiovascular complications and is associated with excess morbidity and mortality. Despite multiple effective options for reducing hyperglycemia, patients are not optimally managed, largely due to delays in appropriate and timely advancement of therapy. Glucagon-like peptide-1 receptor agonists and basal insulin are recommended by treatment guidelines as effective options for advancing therapy to achieve glycemic control. However, injected therapies often face resistance from patients and clinicians. Glucagon-like peptide-1 receptor agonists are associated with weight loss, low risk of hypoglycemia, and potential beneficial cardiovascular effects. The class is recommended for patients across the spectrum of disease severity and represents an attractive option to add to basal insulin therapy when additional control is needed. Newer second-generation basal insulin analogues offer advantages over first-generation basal insulins in terms of lower hypoglycemia rates and greater flexibility in dosing. Incorporating injectable therapy into patient care in a timely manner has the potential to improve outcomes and must not be overlooked. Primary care clinicians play a significant role in managing patients with T2D, and they must be able to address and overcome patient resistance and their own barriers to advancing therapy if optimal treatment outcomes are to be achieved. The purpose of this expert opinion article was to provide a commentary on the key principle of advancing therapy with injectables to control hyperglycemia.
2 型糖尿病（T2D）是一种由胰岛素抵抗和相关的β细胞功能逐渐下降以及多种其他相关代谢和病理生理变化引起的进行性疾病。如果不加控制，T2D 会增加长期微血管和心血管并发症的风险，并与过高的发病率和死亡率相关。尽管有多种有效方法可以降低高血糖，但患者的治疗效果并不理想，主要是由于治疗的适当和及时进展存在延迟。治疗指南推荐胰高血糖素样肽-1 受体激动剂和基础胰岛素作为推进治疗以实现血糖控制的有效选择。然而，注射疗法常常面临患者和临床医生的抵制。胰高血糖素样肽-1 受体激动剂与体重减轻、低血糖风险低和潜在的心血管获益相关。该类别适用于疾病严重程度谱内的患者，当需要额外控制时，代表了添加到基础胰岛素治疗的有吸引力的选择。新一代基础胰岛素类似物在低血糖发生率较低和剂量更灵活方面优于第一代基础胰岛素。及时将注射疗法纳入患者护理中有可能改善治疗效果，不容忽视。初级保健临床医生在管理 T2D 患者方面发挥着重要作用，如果要实现最佳的治疗效果，他们必须能够解决和克服患者的抵制以及自己在推进治疗方面的障碍。本文的目的是对用注射剂控制高血糖的治疗推进的关键原则进行评论。
