Leahy John Jack L, Aleppo Grazia, Fonseca Vivian A, Garg Satish K, Hirsch Irl B, McCall Anthony L, McGill Janet B, Polonsky William H
University of Vermont College of Medicine, Burlington, Vermont.
Northwestern University Feinberg School of Medicine, Chicago, Illinois.
J Endocr Soc. 2019 Oct 7;3(10):1942-1957. doi: 10.1210/js.2019-00222. eCollection 2019 Oct 1.
Faster-acting insulins, new noninsulin drug classes, more flexible insulin-delivery systems, and improved continuous glucose monitoring devices offer unprecedented opportunities to improve postprandial glucose (PPG) management and overall care for adults with insulin-treated diabetes. These developments led the Endocrine Society to convene a working panel of diabetes experts in December 2018 to assess the current state of PPG management, identify innovative ways to improve self-management and quality of life, and align best practices to current and emerging treatment and monitoring options. Drawing on current research and collective clinical experience, we considered the following issues for the ∼200 million adults worldwide with type 1 and insulin-requiring type 2 diabetes: (i) the role of PPG management in reducing the risk of diabetes complications; (ii) barriers preventing effective PPG management; (iii) strategies to reduce PPG excursions and improve patient quality of life; and (iv) education and clinical tools to support endocrinologists in improving PPG management. We concluded that managing PPG to minimize or prevent diabetes-related complications will require elucidating fundamental questions about optimal ways to quantify and clinically assess the metabolic dysregulation and consequences of the abnormal postprandial state in diabetes and recommend research strategies to address these questions. We also identified practical strategies and tools that are already available to reduce barriers to effective PPG management, optimize use of new and emerging clinical tools, and improve patient self-management and quality of life.
速效胰岛素、新型非胰岛素药物类别、更灵活的胰岛素给药系统以及改进的持续葡萄糖监测设备，为改善餐后血糖（PPG）管理以及为接受胰岛素治疗的成年糖尿病患者提供全面护理带来了前所未有的机遇。这些进展促使内分泌学会在2018年12月召集了一个糖尿病专家工作小组，以评估PPG管理的现状，确定改善自我管理和生活质量的创新方法，并使最佳实践与当前及新出现的治疗和监测选择保持一致。基于当前的研究和集体临床经验，我们针对全球约2亿1型糖尿病患者和需要胰岛素治疗的2型糖尿病成年患者考虑了以下问题：（i）PPG管理在降低糖尿病并发症风险中的作用；（ii）阻碍有效PPG管理的因素；（iii）减少PPG波动和改善患者生活质量的策略；（iv）支持内分泌科医生改善PPG管理的教育和临床工具。我们得出结论，要管理PPG以尽量减少或预防糖尿病相关并发症，需要阐明关于量化和临床评估糖尿病餐后异常状态的代谢失调及其后果的最佳方法的基本问题，并推荐解决这些问题的研究策略。我们还确定了一些实用的策略和工具，这些策略和工具已经可以用来减少有效PPG管理的障碍，优化新出现的临床工具的使用，并改善患者的自我管理和生活质量。
