Natsir Ramdhani M, Halimah Eli, Diantini Ajeng, Levita Jutti
Doctoral Program in Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Sumedang, Indonesia.
Department of Medical Laboratory Technology, Maluku Health Polytechnic of the Ministry of Health, Ambon, Indonesia.
Diabetes Metab Syndr Obes. 2025 Sep 3;18:3215-3236. doi: 10.2147/DMSO.S545571. eCollection 2025.
Insulin therapy remains a cornerstone in the management of type 2 diabetes mellitus (T2DM), especially in patients experiencing progressive loss of pancreatic beta-cell function or those with inadequate glycemic control despite oral antidiabetic therapy. This review synthesized clinical outcomes from 44 peer-reviewed case reports published between 2019 and 2024, identified through systematic searches in PubMed and Scopus. The included cases involved 15 males and 29 females, with patient ages ranging from 11 to 91 years (mean 53 ± 20.85 years). Subcutaneous insulin was the most frequently used route of administration, while intravenous insulin was reserved for managing acute complications. The most commonly reported complication was diabetic ketoacidosis (DKA), especially in patients with delayed insulin initiation or in those receiving sodium-glucose cotransporter 2 (SGLT2) inhibitors, a class of oral glucose-lowering agents, one of whose side effects is known to elevate the risk of euglycemic DKA. Other triggers included COVID-19 infection and severe insulin resistance. Most patients received basal insulin regimens, whereas basal-bolus combinations were preferred in more complex or unstable cases. Insulin was frequently combined with oral agents, such as metformin, dipeptidyl peptidase IV (DPP-IV) inhibitors, glucagon-like peptide 1 (GLP-1) receptor agonists, or sodium-glucose cotransporter 2 (SGLT2) inhibitors, reflecting a trend toward individualized treatment strategies. Biomarkers such as glycated hemoglobin (HbA1c) and C-reactive protein (CRP) were routinely used to monitor glycemic control and systemic inflammation. These findings underscore the clinical importance of early insulin initiation, continuous monitoring, and personalized regimens to improve outcomes in advanced or complicated T2DM. Emerging therapies, such as once-weekly basal insulin formulations, show promise for enhancing adherence and glucose stability, although further research is needed to evaluate their long-term effectiveness and cost-efficiency.
胰岛素治疗仍然是2型糖尿病（T2DM）管理的基石，特别是对于那些胰腺β细胞功能逐渐丧失的患者，或尽管接受口服抗糖尿病治疗但血糖控制不佳的患者。本综述综合了2019年至2024年间发表的44篇经同行评审的病例报告的临床结果，这些报告是通过在PubMed和Scopus中进行系统检索确定的。纳入的病例包括15名男性和29名女性，患者年龄从11岁到91岁不等（平均53±20.85岁）。皮下注射胰岛素是最常用的给药途径，而静脉注射胰岛素则用于处理急性并发症。最常报告的并发症是糖尿病酮症酸中毒（DKA），特别是在胰岛素起始延迟的患者或接受钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂的患者中，这是一类口服降糖药，其副作用之一是已知会增加正常血糖性DKA的风险。其他诱因包括新冠病毒感染和严重胰岛素抵抗。大多数患者接受基础胰岛素治疗方案，而在更复杂或不稳定的病例中，基础-餐时联合方案更受青睐。胰岛素经常与口服药物联合使用，如二甲双胍、二肽基肽酶IV（DPP-IV）抑制剂、胰高血糖素样肽1（GLP-1）受体激动剂或钠-葡萄糖协同转运蛋白2（SGLT2）抑制剂，这反映了个体化治疗策略的趋势。糖化血红蛋白（HbA1c）和C反应蛋白（CRP）等生物标志物经常用于监测血糖控制和全身炎症。这些发现强调了早期胰岛素起始、持续监测和个性化治疗方案对于改善晚期或复杂T2DM患者结局的临床重要性。新兴疗法，如每周一次的基础胰岛素制剂，显示出提高依从性和血糖稳定性的前景，尽管需要进一步研究来评估其长期有效性和成本效益。
