The Current and Future Role of Insulin Therapy in the Management of Type 2 Diabetes: A Narrative Review

IF 3.8 3区医学 Q2 Medicine

Diabetes Therapy Pub Date : 2024-04-04 DOI:10.1007/s13300-024-01569-8

Janet B. McGill, Irl B. Hirsch, Christopher G. Parkin, Grazia Aleppo, Carol J. Levy, James R. Gavin

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引用次数: 0

Abstract

Early initiation of intensive insulin therapy has been demonstrated to be effective in controlling glycemia and possibly preserving beta-cell function. Innovations in insulin formulations and delivery systems continue. However, we have seen an acceleration in the development of new classes of diabetes medications for individuals with type 2 diabetes and obesity, such as, for example, glucagon-like peptide-1 receptor agonists (GLP-1 RAs). These formulations have been shown to confer significant benefits in achieving good glycemic control with reduced hypoglycemia risk, weight loss, and cardiorenal protection. Therefore, it is reasonable to question whether there is still a role for insulin therapy in the management of type 2 diabetes. However, there are clear limitations inherent to GLP-1 RA therapy, including high rates of suboptimal adherence and treatment discontinuation due to high cost and side effects, which diminish long-term efficacy, and supply issues. In addition, newer formulations have shown improvements in convenience and tolerability, and have been shown to be even more effective when used in conjunction with basal insulin. In this narrative review, we discuss current evidence that supports GLP-1 RA use in combination with insulin therapy and the potential pitfalls of reliance on GLP-1 RAs as a substitute for insulin therapy.

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胰岛素疗法在 2 型糖尿病治疗中的当前和未来作用：叙述性综述

事实证明，尽早开始强化胰岛素治疗可有效控制血糖，并有可能保护β细胞功能。胰岛素配方和给药系统的创新仍在继续。不过，我们也看到，针对 2 型糖尿病和肥胖症患者的新型糖尿病药物正在加速开发，例如胰高血糖素样肽-1 受体激动剂（GLP-1 RAs）。这些制剂已被证明在实现良好血糖控制、降低低血糖风险、减轻体重和保护心肾功能方面具有显著优势。因此，有理由质疑胰岛素疗法在 2 型糖尿病的治疗中是否仍有作用。然而，GLP-1 RA 疗法也存在明显的固有局限性，包括由于成本高、副作用大（降低了长期疗效）和供应问题导致的次优依从率高和治疗中断率高。此外，较新的制剂在方便性和耐受性方面有所改进，而且与基础胰岛素联合使用时效果更好。在这篇叙述性综述中，我们将讨论支持 GLP-1 RA 与胰岛素疗法联合使用的现有证据，以及依赖 GLP-1 RA 替代胰岛素疗法的潜在隐患。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes Therapy Medicine-Endocrinology, Diabetes and Metabolism

CiteScore

6.90

自引率

7.90%

发文量

130

审稿时长

6 weeks

期刊介绍： Diabetes Therapy is an international, peer reviewed, rapid-publication (peer review in 2 weeks, published 3–4 weeks from acceptance) journal dedicated to the publication of high-quality clinical (all phases), observational, real-world, and health outcomes research around the discovery, development, and use of therapeutics and interventions (including devices) across all areas of diabetes. Studies relating to diagnostics and diagnosis, pharmacoeconomics, public health, epidemiology, quality of life, and patient care, management, and education are also encouraged. The journal is of interest to a broad audience of healthcare professionals and publishes original research, reviews, communications and letters. The journal is read by a global audience and receives submissions from all over the world. Diabetes Therapy will consider all scientifically sound research be it positive, confirmatory or negative data. Submissions are welcomed whether they relate to an international and/or a country-specific audience, something that is crucially important when researchers are trying to target more specific patient populations. This inclusive approach allows the journal to assist in the dissemination of all scientifically and ethically sound research.