Adam G Tabak, Peter Kempler, Cristian Guja, Roy Eldor, Martin Haluzik, Tomasz Klupa, Nikolaos Papanas, Anca Pantea Stoian, Boris Mankovsky
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Early insulin administration has several advantages including reduced glucotoxicity, high efficacy and preserved β-cell mass/function, leading to lowering the risk of diabetes complications. The current publication is based on consensus of experts from the South-Eastern European region and Israel who reviewed the existing evidence and guidelines for the treatment of PwT2D. Herein, the experts emphasised the timely use of insulin, preferably second-generation basal insulin (BI) analogues and intensification using basal-plus therapy, as the most-potent glucose-lowering treatment choice in the real-world clinical setting. Despite an increase in the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the experts urged timely insulin initiation for inadequate glycaemic control in PwT2D. Furthermore, the combination of BI and GLP-1 RA addressing both fasting plasma glucose and post-prandial excursions as a free- or fixed-ratio combination was identified to reduce treatment complexity and burden. To minimise discontinuation and improve adherence, the experts reiterated quality, regular interactions and discussions between HCPs and PwT2D/carers for their involvement in the diabetes management decision-making process. 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引用次数: 0
摘要
尽管有各种抗高血糖疗法和全面的指南,但在过去十年中,糖尿病管理中的血糖控制在实际临床环境中并没有得到显著改善。患者、临床医生和医疗系统相关因素之间复杂的相互作用所产生的治疗惰性是血糖控制不理想的主要原因。此外,导致血糖水平不达标的关键因素仍然是医护人员(HCPs)与 2 型糖尿病患者(PwT2D)之间的沟通有限。早期使用胰岛素具有多种优势,包括降低葡萄糖毒性、疗效高、保留β细胞质量/功能,从而降低糖尿病并发症的风险。来自东南欧地区和以色列的专家对治疗 PwT2D 的现有证据和指南进行了审查,并在此基础上达成了共识。在此,专家们强调,及时使用胰岛素,最好是第二代基础胰岛素(BI)类似物,并加强使用基础胰岛素+疗法,这是实际临床环境中最有效的降糖治疗选择。尽管胰高血糖素样肽-1 受体激动剂(GLP-1 RAs)的使用有所增加,但专家们仍敦促在 PwT2D 血糖控制不佳时及时开始使用胰岛素。此外,专家们还确定了 BI 和 GLP-1 RA 的自由或固定比例组合,以解决空腹血浆葡萄糖和餐后血糖偏高的问题,从而降低治疗的复杂性和负担。为了最大限度地减少停药并提高依从性,专家们重申,在糖尿病管理决策过程中,医疗保健人员和糖尿病患者/护理人员应定期进行高质量的互动和讨论。临床医生和保健医生应根据最新的糖尿病管理建议考虑专家的意见。
Expert Opinion on Current Trends in the Use of Insulin in the Management of People with Type 2 Diabetes from the South-Eastern European Region and Israel.
Despite the availability of various antihyperglycaemic therapies and comprehensive guidelines, glycaemic control in diabetes management has not improved significantly during the last decade in the real-world clinical setting. Treatment inertia arising from a complex interplay among patient-, clinician- and healthcare-system-related factors is the prime reason for this suboptimal glycaemic control. Also, the key factor leading to inadequate glycaemic levels remains limited communication between healthcare professionals (HCPs) and people with type 2 diabetes (PwT2D). Early insulin administration has several advantages including reduced glucotoxicity, high efficacy and preserved β-cell mass/function, leading to lowering the risk of diabetes complications. The current publication is based on consensus of experts from the South-Eastern European region and Israel who reviewed the existing evidence and guidelines for the treatment of PwT2D. Herein, the experts emphasised the timely use of insulin, preferably second-generation basal insulin (BI) analogues and intensification using basal-plus therapy, as the most-potent glucose-lowering treatment choice in the real-world clinical setting. Despite an increase in the use of glucagon-like peptide-1 receptor agonists (GLP-1 RAs), the experts urged timely insulin initiation for inadequate glycaemic control in PwT2D. Furthermore, the combination of BI and GLP-1 RA addressing both fasting plasma glucose and post-prandial excursions as a free- or fixed-ratio combination was identified to reduce treatment complexity and burden. To minimise discontinuation and improve adherence, the experts reiterated quality, regular interactions and discussions between HCPs and PwT2D/carers for their involvement in the diabetes management decision-making process. Clinicians and HCPs should consider the opinions of the experts in accordance with the most recent recommendations for diabetes management.
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.