Harris Stewart B, Parente Erika B, Karalliedde Janaka
Schulich School of Medicine & Dentistry at The University of Western Ontario, in London, 1151 Richmond St, London, ON, N6A 5C1, Canada.
Folkhälsan Research Center, Helsinki, Finland.
Diabetes Ther. 2022 May;13(5):913-930. doi: 10.1007/s13300-022-01247-7. Epub 2022 Mar 30.
Type 2 diabetes (T2D) is a progressive disease, with many individuals eventually requiring basal insulin therapy to maintain glycaemic control. However, there exists considerable therapeutic inertia to the prompt initiation and optimal titration of basal insulin therapy due to barriers that include fear of injections, hypoglycaemia, weight gain, and burdensome regimens. Hypoglycaemia is thought to be a major barrier to optimal glycaemic control and is associated with significant morbidity and mortality. Newer second-generation basal insulin analogues provide comparable glycaemic control with lower risk of hypoglycaemia compared with first-generation basal insulin analogues. The present review article discusses clinical evidence for one such second-generation basal insulin analogue, insulin glargine 300 U/mL (Gla-300), in the context of hypothetical case studies that are representative of individuals who may attend routine clinical practice. These case studies discuss individualised treatment needs for people with T2D who are insulin-naïve or pre-treated. Clinical characteristics such as older age, frequent nocturnal hypoglycaemia, and renal impairment, which are known risk factors for hypoglycaemia, are also considered.
2型糖尿病（T2D）是一种进行性疾病，许多患者最终需要基础胰岛素治疗来维持血糖控制。然而，由于包括害怕注射、低血糖、体重增加和治疗方案繁琐等障碍，在基础胰岛素治疗的及时启动和最佳滴定方面存在相当大的治疗惰性。低血糖被认为是实现最佳血糖控制的主要障碍，并且与显著的发病率和死亡率相关。与第一代基础胰岛素类似物相比，新型第二代基础胰岛素类似物能提供相当的血糖控制，同时低血糖风险更低。本综述文章在一些假设案例研究的背景下，讨论了一种此类第二代基础胰岛素类似物——甘精胰岛素300 U/mL（Gla-300）的临床证据，这些案例研究代表了可能就诊于常规临床实践的个体。这些案例研究讨论了初治或已接受过治疗的T2D患者的个体化治疗需求。还考虑了已知的低血糖风险因素，如老年、频繁夜间低血糖和肾功能损害等临床特征。
