Bajaj Sarita, Das A K, Kalra Sanjay, Sahay Rakesh, Saboo Banshi, Das Sambit, Shunmugavelu M, Jacob Jubbin, Priya Gagan, Khandelwal Deepak, Dutta Deep, Chawla Manoj, Surana Vineet, Tiwaskar Mangesh, Joshi Ameya, Shrestha Pradip Krishna, Bhattarai Jyoti, Bhowmik Bishwajit, Latt Tint Swe, Aye Than Than, Vijayakumar G, Baruah Manash, Jawad Fatema, Unnikrishnan A G, Chowdhury Subhankar, Pathan Md Faruqe, Somasundaram Noel, Sumanathilaka Manilka, Raza Abbas, Bahendeka Silver K, Coetzee Ankia, Ruder Sundeep, Ramaiya Kaushik, Lamptey Roberta, Bavuma Charlotte, Shaikh Khalid, Uloko Andrew, Chaudhary Sandeep, Abdela Abdurezak Ahmed, Akanov Zhanay, Rodrìguez-Saldaña Joel, Faradji Raquel, Tiago Armindo, Reja Ahmed, Czupryniak Leszek
Department of Medicine, MLN Medical College, Allahabad, India.
Department of Medicine, JIPMER, Puducherry, India.
Diabetes Ther. 2019 Aug;10(4):1189-1204. doi: 10.1007/s13300-019-0629-z. Epub 2019 May 17.
The past three decades have seen a quadruple rise in the number of people affected by diabetes mellitus worldwide, with the disease being the ninth major cause of mortality. Type 2 diabetes mellitus (T2DM) often remains undiagnosed for several years due to its asymptomatic nature during the initial stages. In India, 70% of diagnosed diabetes cases remain uncontrolled. Current guidelines endorse the initiation of insulin early in the course of the disease, specifically in patients with HbA1c > 10%, as the use of oral agents alone is unlikely to achieve glycemic targets. Early insulin initiation and optimization of glycemic control using insulin titration algorithms and patient empowerment can facilitate the effective management of uncontrolled diabetes. Early glucose control has sustained benefits in people with diabetes. However, insulin initiation, dose adjustment, and the need to repeatedly assess blood glucose levels are often perplexing for both physicians and patients, and there are misconceptions and concerns regarding its use. Hence, an early transition to insulin and ideal intensification of treatment may aid in delaying the onset of diabetes complications. This opinion statement was formulated by an expert panel on the basis of existing guidelines, clinical experience, and economic and cultural contexts. The statement stresses the timely and appropriate use of basal insulin in T2DM. It focuses on the seven vital Ts-treatment initiation, timing of administration, transportation and storage, technique of administration, targets for titration, tablets, and tools for monitoring.Funding: Sanofi.
在过去三十年中，全球受糖尿病影响的人数增长了四倍，糖尿病成为第九大主要死因。2型糖尿病（T2DM）在疾病初期通常无症状，因此常常多年未被诊断出来。在印度，70%的已诊断糖尿病病例仍未得到有效控制。当前指南支持在疾病进程早期开始使用胰岛素，特别是对于糖化血红蛋白（HbA1c）>10%的患者，因为仅使用口服药物不太可能实现血糖目标。早期启动胰岛素治疗，并通过胰岛素滴定算法和患者教育来优化血糖控制，有助于有效管理未得到控制的糖尿病。早期血糖控制对糖尿病患者具有持续的益处。然而，胰岛素的起始使用、剂量调整以及反复评估血糖水平的必要性，常常让医生和患者都感到困惑，而且对于胰岛素的使用还存在误解和担忧。因此，尽早转换为胰岛素治疗并进行理想的强化治疗，可能有助于延缓糖尿病并发症的发生。本观点声明由一个专家小组根据现有指南、临床经验以及经济和文化背景制定。该声明强调在T2DM中及时、适当地使用基础胰岛素。它聚焦于七个关键的“T”——治疗起始、给药时间、运输与储存、给药技术、滴定目标、片剂以及监测工具。资助：赛诺菲。
