Rumié Carmi Hana Karime, Domínguez-Menéndez Gonzalo, Araya Manuel, Martínez-Aguayo Alejandro
Pontificia Universidad Católica de Chile, Santiago, Chile.
University of British Columbia, Vancouver, Canada.
Andes Pediatr. 2023 Jun;94(3):278-285. doi: 10.32641/andespediatr.v94i3.4477.
Insulin therapy is complex in pediatric patients because they present greater variations in insulin requirements. Traditional insulins have limitations related to time of onset of action and duration of effect, which has led to the development of new insulins, seeking to reduce chronic complications, severe or nocturnal hypoglycemia, and to improve adherence to therapy. This review updates the information on new insulins, their mechanisms of action and the benefits they provide in the treatment of diabetes. Insulin analogues attempt to mimic the physiological secretion of the hormone, including time of action and duration of effect. The most used prandial analogs are the so-called rapid-acting insulins, including Faster Aspartic and the new basal insulins, glargine U300 and degludec, which have a prolonged action of more than 24 hours and therefore require a daily dose. New technologies under development include biosimilar insulins such as the glargine biosimilar, already available in the clinic. New formulations are being developed for the future, as well as novel ways of dispersing them, mimicking the action of pancreatic cells, which will allow a more physiological and personalized management of the disease.
胰岛素治疗在儿科患者中较为复杂，因为他们的胰岛素需求量差异更大。传统胰岛素在起效时间和作用持续时间方面存在局限性，这促使了新型胰岛素的研发，旨在减少慢性并发症、严重或夜间低血糖，并提高治疗依从性。本综述更新了有关新型胰岛素及其作用机制以及它们在糖尿病治疗中所带来益处的信息。胰岛素类似物试图模拟激素的生理分泌，包括作用时间和持续时间。最常用的餐时类似物是所谓的速效胰岛素，包括门冬胰岛素，以及新型基础胰岛素，如甘精胰岛素U300和德谷胰岛素，它们具有超过24小时的长效作用，因此需要每日给药一次。正在研发的新技术包括生物类似胰岛素，如临床上已有的甘精胰岛素生物类似物。未来还在开发新的制剂以及新型给药方式，以模拟胰腺细胞的作用，从而实现对该疾病更符合生理和个性化的管理。
