PDF(Pubmed)
Abstract：
The prevalence of type 2 diabetes mellitus has been increasing worldwide. As the therapeutic options for type 2 diabetes mellitus have evolved over the last 2 decades, national and global guidelines related to type 2 diabetes mellitus pharmacotherapy issued by various organizations have tended to vary in their recommendations. This narrative review aimed to analyze the key recommendations by major global and national guidelines on the initiation of insulin therapy in patients with type 2 diabetes mellitus over the last 20 years. Strategies for insulin therapy for titration and intensification were also assessed. All guidelines recommend initiation of insulin (basal/ premixed/other formulations) when glycemic targets are not achieved despite lifestyle measures and oral antidiabetic drugs. In the recent decade, early initiation of insulin has been recommended when the glycated hemoglobin levels are >10% or blood glucose levels are ≥300 mg/dL (16.7 mmol/L). Initiation is recommended at a dose of 10 units or 0.1-0.2 U/kg. Titration is advised to achieve the optimal dosage, while intensification is recommended when glycemic targets are not achieved despite titrating to an acceptable level. Glucose monitoring at periodic intervals is recommended for adequate glycemic control. The guidelines further suggest that the choice of insulin should be individualized, considering the clinical status of patients with type 2 diabetes mellitus. The physicians as well as patients should be a part of the decisions made regarding the therapeutic choice of regimen, preparation, and delivery device.
摘要：
2型糖尿病的患病率在世界范围内一直在增加。随着2型糖尿病的治疗选择在过去的20年里不断发展，不同组织发布的与2型糖尿病药物治疗相关的国家和全球指南的建议往往有所不同.这篇叙述性综述旨在分析过去20年来主要的全球和国家指南对2型糖尿病患者开始胰岛素治疗的主要建议。还评估了用于滴定和强化的胰岛素治疗策略。尽管采取了生活方式措施和口服抗糖尿病药物，但所有指南都建议在未达到血糖目标时开始使用胰岛素（基础/预混/其他制剂）。在最近的十年里,当糖化血红蛋白水平>10%或血糖水平≥300mg/dL(16.7mmol/L)时,建议尽早开始胰岛素治疗.建议以10单位或0.1-0.2U/kg的剂量开始。建议滴定以达到最佳剂量，而当尽管滴定至可接受的水平但仍未达到血糖目标时，建议强化。建议定期监测葡萄糖以充分控制血糖。该指南进一步建议胰岛素的选择应个体化，考虑2型糖尿病患者的临床状况。医生和患者应该是关于治疗方案选择的决定的一部分，准备,和输送装置。
