De Block Christophe E M, Van Cauwenberghe Jolijn, Bochanen Niels, Dirinck Eveline
Department of Endocrinology, Diabetology & Metabolism, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.
University of Antwerp, Faculty of Medicine & Health Sciences, Laboratory of Experimental Medicine and Paediatrics (LEMP), Wilrijk, Belgium.
Diabetes Obes Metab. 2022 Jan;24 Suppl 1:63-74. doi: 10.1111/dom.14713. Epub 2022 Apr 25.
Since the discovery of insulin 100 years ago, insulin preparations have improved significantly. Starting from purified animal insulins, evolving to human insulins produced by genetically modified organisms, and ultimately to insulin analogues, all in an attempt to mimic physiological insulin action profiles seen in individuals without diabetes. Achieving strict glucose control without hypoglycaemia and preventing chronic complications of diabetes while preserving quality of life remains a challenging goal, but the advent of newer ultra-rapid-acting insulin analogues may enable intensive insulin therapy without being too disruptive to daily life. Ultra-rapid-acting insulin analogues can be administered shortly before meals and give better coverage of mealtime-induced glucose excursions than conventional insulin preparations. They also increase convenience with timing of bolus dosing. In this review, we focus on the progress that has been made in rapid-acting insulins. We summarize pharmacokinetic and pharmacodynamic data, clinical trial data supporting the use of these new formulations as part of a basal-bolus regimen and continuous subcutaneous insulin infusion, and provide a clinical perspective to help guide healthcare professionals when and for whom to use ultra-fast-acting insulins.
自100年前发现胰岛素以来，胰岛素制剂有了显著改进。从纯化的动物胰岛素开始，发展到由转基因生物生产的人胰岛素，最终发展到胰岛素类似物，所有这些都是为了模仿非糖尿病个体的生理胰岛素作用模式。在不发生低血糖的情况下实现严格的血糖控制，并在保持生活质量的同时预防糖尿病的慢性并发症，仍然是一个具有挑战性的目标，但是新型超短效胰岛素类似物的出现可能使强化胰岛素治疗不会对日常生活造成太大干扰。超短效胰岛素类似物可在餐前不久给药，与传统胰岛素制剂相比，能更好地覆盖餐时引起的血糖波动。它们还增加了推注给药时间的便利性。在本综述中，我们重点关注速效胰岛素方面取得的进展。我们总结了药代动力学和药效学数据、支持将这些新制剂用作基础-餐时胰岛素方案和持续皮下胰岛素输注一部分的临床试验数据，并提供临床观点，以帮助指导医疗保健专业人员何时以及为谁使用超短效胰岛素。
