Glastras Sarah J, Cohen Neale, Dover Thomas, Kilov Gary, MacIsaac Richard J, McGill Margaret, Fulcher Greg R
Department of Diabetes, Endocrinology and Metabolism, The Royal North Shore Hospital, The University of Sydney, Reserve Road, St Leonards, NSW 2065, Australia.
Baker Heart and Diabetes Institute, 75 Commercial Road, Melbourne, VIC 3004, Australia.
J Clin Med. 2020 Apr 11;9(4):1091. doi: 10.3390/jcm9041091.
Treatment intensification in people with type 2 diabetes following failure of basal insulin commonly involves the addition of a rapid-acting insulin analogue (basal plus one or more prandial doses; multiple daily injections) or by a switch to premixed insulin. Insulin degludec/insulin aspart (IDegAsp), comprising rapid-acting insulin aspart and ultra-long-acting insulin degludec in solution, enables both fasting and post-prandial glucose control, with some advantages over other treatment intensification options. These include straightforward dose titration, flexibility in dose timing, low injection burden, simplicity of switching and a lower risk of hypoglycaemia. In Australia, where insulin degludec on its own is not available, IDegAsp enables patients to still benefit from its ultra-long-acting properties. This review aims to provide guidance on where and how to use IDegAsp. Specifically, guidance is included on the initiation of IDegAsp in insulin-naïve patients, treatment intensification from basal insulin, switching from premixed or basal-bolus insulin to IDegAsp, up-titration from once- to twice-daily IDegAsp and the use of IDegAsp in special populations or situations.
基础胰岛素治疗失败后的2型糖尿病患者强化治疗通常包括加用速效胰岛素类似物（基础胰岛素加一次或多次餐时剂量；每日多次注射）或换用预混胰岛素。德谷胰岛素/门冬胰岛素（IDegAsp），即溶液中的速效门冬胰岛素和超长效德谷胰岛素，可实现空腹和餐后血糖控制，相较于其他强化治疗方案具有一些优势。这些优势包括剂量滴定简单、给药时间灵活、注射负担低、转换简便以及低血糖风险较低。在澳大利亚，单独使用德谷胰岛素无法实现，IDegAsp使患者仍能受益于其超长效特性。本综述旨在为IDegAsp的使用地点和方式提供指导。具体而言，包括了在未使用过胰岛素的患者中起始使用IDegAsp、从基础胰岛素强化治疗、从预混胰岛素或基础-餐时胰岛素转换为IDegAsp、从每日一次IDegAsp滴定至每日两次以及在特殊人群或情况下使用IDegAsp的指导。
