Department of Endocrinology, Center for Endocrinology Diabetes Arthritis & Rheumatism (CEDAR) Superspecialty Clinics, Dwarka, New Delhi, India.
Department of Endocrinology, Maharaja Agrasen Hospital, New Delhi, India.
Expert Opin Drug Metab Toxicol. 2020 Mar;16(3):209-216. doi: 10.1080/17425255.2020.1735351. Epub 2020 Mar 2.
: This review focuses on currently available injectable combination therapies (ICTs) for managing diabetes.: References were identified through searches of PubMed, Medline, and Embase for articles published till July 2019 using terms 'insulin' [MeSH Terms] OR 'glucagon like peptide 1 analogue' [All Fields] OR 'combination therapy' [All Fields] 'combination insulin therapy' [All Fields] OR 'combination GLP1 analogue therapy' [All Fields] OR 'premixed insulin' [All Fields].: Currently, there are nine types of ICTs for diabetes available. ICTs are classified on the basis of whether they are combinations of conventional human insulin, human insulin analogs, insulin coformulations, and insulin glucagon-like peptide-1 receptor agonists (GLP-1RA) and have a subtle difference in pharmacokinetic and pharmacodynamic properties. ICTs have been consistently demonstrated to play a major role in improving glycemic control. In a different meta-analysis involving patients assessed for glycemic control as the primary endpoint, no significant difference was noted with regard to HbA1c reduction, hypoglycemia, weight change, and daily insulin dose in patients on basal-bolus regimen, as compared to ICTs. All international guidelines recommend ICTs for treatment intensification.ICTs provide more flexibility to the treating doctor in fine-tuning the insulin/GLP-1RA regimen and have the advantages of reducing daily needle-prick count and better long-term compliance.
这篇综述聚焦于目前可用于糖尿病管理的注射用复方治疗药物(ICTs)。检索 PubMed、Medline 和 Embase 数据库,检索词包括“胰岛素”[MeSH 主题词]或“胰高血糖素样肽 1 类似物”[所有字段]或“联合治疗”[所有字段]“联合胰岛素治疗”[所有字段]或“联合 GLP1 类似物治疗”[所有字段]或“预混胰岛素”[所有字段],检索时限为 2019 年 7 月之前,共纳入了 9 种不同类型的 ICTs 用于治疗糖尿病。根据 ICTs 中是否包含常规人胰岛素、人胰岛素类似物、胰岛素复方制剂以及胰岛素胰高血糖素样肽-1 受体激动剂(GLP-1RA),将其进行分类,这些药物在药代动力学和药效学特性上存在细微差异。ICTs 一直被证明在改善血糖控制方面发挥着重要作用。在另一项涉及以血糖控制为主要终点的患者评估的荟萃分析中,与基础-餐时胰岛素方案相比,ICTs 并不能显著降低糖化血红蛋白(HbA1c)、低血糖、体重变化和每日胰岛素剂量。所有国际指南都建议将 ICTs 用于治疗强化。ICTs 为治疗医生提供了更大的灵活性,以调整胰岛素/GLP-1RA 方案,具有减少每日针刺次数和提高长期依从性的优点。