Toth E L, Lee K C
Department of Medicine, Heritage Medical Research Centre, University of Alberta, Edmonton.
Can Fam Physician. 1998 Nov;44:2444-9.
To review the best evidence-based literature on the insulin analogue, lispro insulin, and to provide guidelines for its use.
Using the MeSH terms, lispro and insulin analogues, we searched PubMed, Current Contents, MEDLINE, and EMBASE from January 1986 to July 1998 and selected 42 articles out of 97 for high quality and relevance to family medicine. Twenty-eight were randomized controlled trials, but only two studies were blinded because lispro and regular insulin have different optimal times of administration.
The new insulin analogue, lispro, produces a much more rapid, higher, and shorter-lasting peak level of insulin than regular human insulin, thus mimicking physiologic secretion of insulin more closely. This allows insulin administration just before or just after meals and means patients can manage with fewer snacks. Lispro controls postprandial blood glucose levels better and does not cause hypoglycemia. Although most older studies showed no change in glycosylated hemoglobin (HbA1c) levels, a few recent studies involving refinements, such as continuous subcutaneous insulin infusion or basal insulin to reduce preprandial glucose levels, have found small but significant improvements. Insulin lispro has also been used successfully in cases of insulin resistance and insulin allergy.
Lispro is a useful addition for motivated diabetic patients who like to achieve better control of HbA1c without increased hypoglycemia and to match mealtime insulin injections with diet, exercise, and various lifestyles.
回顾关于胰岛素类似物赖脯胰岛素的最佳循证医学文献，并提供其使用指南。
使用医学主题词“赖脯胰岛素”和“胰岛素类似物”，我们检索了1986年1月至1998年7月期间的PubMed、《现刊目次》、MEDLINE和EMBASE，从97篇文章中筛选出42篇高质量且与家庭医学相关的文章。其中28篇为随机对照试验，但只有两项研究采用了盲法，因为赖脯胰岛素和常规胰岛素的最佳给药时间不同。
新型胰岛素类似物赖脯胰岛素比常规人胰岛素产生更快、更高且持续时间更短的胰岛素峰值水平，因此更接近胰岛素的生理分泌。这使得胰岛素可在餐前或餐后即刻给药，意味着患者可以减少零食摄入。赖脯胰岛素能更好地控制餐后血糖水平且不会引起低血糖。尽管大多数早期研究显示糖化血红蛋白（HbA1c）水平没有变化，但最近一些涉及改进措施（如持续皮下胰岛素输注或基础胰岛素以降低餐前血糖水平）的研究发现有小幅但显著的改善。赖脯胰岛素在胰岛素抵抗和胰岛素过敏的病例中也已成功应用。
对于希望在不增加低血糖风险的情况下更好地控制HbA1c，并使餐时胰岛素注射与饮食、运动及各种生活方式相匹配的积极的糖尿病患者来说，赖脯胰岛素是一种有用的补充药物。
