Department of Endocrinology, University Hospitals Leuven , Leuven, Belgium.
Expert Opin Drug Saf. 2021 Feb;20(2):155-169. doi: 10.1080/14740338.2021.1856813. Epub 2021 Jan 18.
: The aim of insulin replacement in insulin-deficient people (type 1 diabetes, pancreatic causes of diabetes, long-standing type 2 diabetes) is to approximate the physiologic insulin action profile as closely as possible. However, short-acting human insulins start too slow and act too long, causing postprandial hyperglycemia and delayed hypoglycemia, while the insulin action profile of long-acting human insulins is too variable in duration and strength of action, leading to insufficient basal insulin covering and peak insulin levels after injection causing early nocturnal hypoglycemia. Insulin analogues were designed to overcome these shortcomings. In insulin-resistant people (type 2 diabetes), insulin analogues contribute to more efficient and safer insulin supplementation. : In this review, we describe the unmet needs for insulin therapy, the currently available short- and long-acting insulin analogues and some considerations on cardiovascular outcomes, use in special populations, and cost-effectiveness. Finally, we discuss what is new in the field of insulin analogues. : The development of insulin analogues is an important step in diabetes treatment. Despite many patients meeting their glycemic targets with the newest analogues, hypoglycemic episodes remain a major problem. More physiologic insulin regimens, with glucose-sensitive or organ-targeting insulin analogues may be the answer to these issues.
胰岛素替代治疗在胰岛素缺乏人群（1 型糖尿病、胰腺性糖尿病、长期 2 型糖尿病）中的目标是尽可能接近生理胰岛素作用谱。然而，短效人胰岛素起效太慢，作用时间太长，导致餐后高血糖和延迟性低血糖，而长效人胰岛素的胰岛素作用谱在持续时间和作用强度方面变化太大，导致基础胰岛素覆盖不足和注射后胰岛素峰值导致早期夜间低血糖。胰岛素类似物的设计旨在克服这些缺点。在胰岛素抵抗人群（2 型糖尿病）中，胰岛素类似物有助于更有效和更安全的胰岛素补充。
在这篇综述中，我们描述了胰岛素治疗的未满足需求、目前可用的短效和长效胰岛素类似物以及一些关于心血管结局、特殊人群使用和成本效益的考虑因素。最后，我们讨论了胰岛素类似物领域的新进展。
胰岛素类似物的发展是糖尿病治疗的重要一步。尽管许多患者通过最新的类似物达到了血糖目标，但低血糖发作仍然是一个主要问题。更生理性的胰岛素方案，包括葡萄糖敏感或器官靶向的胰岛素类似物，可能是解决这些问题的答案。
