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Keywords:

  • glycemic remission;
  • insulin therapy;
  • type 2 diabetes;
  • β-cell function
  • 血糖缓解,胰岛素治疗,2型糖尿病,β细胞功能

Abstract

Type 2 diabetes mellitus (T2DM) is a progressive disease characterized by worsening insulin resistance and a decline in β-cell function. Achieving good glycemic control becomes more challenging as β-cell function continues to deteriorate throughout the disease process. The traditional management paradigm emphasizes a stepwise approach, and insulin has generally been reserved as a final armament. However, mounting evidence indicates that short-term intensive insulin therapy used in the early stages of type 2 diabetes could improve β-cell function, resulting in better glucose control and more extended glycemic remission than oral antidiabetic agents. Improvements in insulin sensitivity and lipid profile were also seen after the early initiation of short-term intensive insulin therapy. Thus, administering short-term intensive insulin therapy to patients with newly diagnosed T2DM has the potential to delay the natural process of this disease, and should be considered when clinicians initiate treatment. Although the early use of insulin is advocated by some guidelines, the optimal time to initiate insulin therapy is not clearly defined or easily recognized, and a pragmatic approach is lacking. Herein we summarize the current understanding of early intensive insulin therapy in patients with newly diagnosed T2DM, focusing on its clinical benefit and problems, as well as possible biological mechanisms of action, and discuss our perspective.

摘要

2型糖尿病是一个以胰岛素抵抗和β细胞功能衰退为特征的进展性疾病。当β细胞功能随着疾病的进展而进行性减退时,如何使血糖得到良好的控制将面临更大的挑战。传统的治疗模式强调阶梯式疗法,胰岛素治疗通常是最后的选择。然而,相当多的证据表明在2型糖尿病早期短期使用胰岛素强化治疗能改善β细胞功能,且与口服降糖药相比,能更好地控制血糖及获得更长的血糖缓解时间。此外,在病程早期启用短期胰岛素强化治疗后胰岛素敏感性及血脂也得到改善。由于初诊2型糖尿病患者短期使用胰岛素强化治疗可能可以延缓疾病自然病程的发展,因此这种起始治疗方案应该得到临床医生的重视。尽管部分指南建议在2型糖尿病病程早期使用胰岛素治疗,但对于起始胰岛素治疗的合适时机并没有进一步的指引和说明,也没有实际可用的治疗方案。在此,我们综述了目前对于初诊2型糖尿病患者短期胰岛素强化治疗的认识,主要关注其临床获益及存在问题,简要介绍可能的生物学机制,并提出我们的观点。