第2型糖尿病是一種常見的慢性疾病,大多數患者必需依賴降血糖藥物以達到血糖控制的目標,口服降血糖藥物通常作爲第一線用藥,但是隨著疾病的進展許多患者無法單獨倚賴口服降血糖藥物達到血糖的控制,因此必須加上胰島素以進一步降低血糖。添加基礎胰島素於原先使用中的口服降血糖藥物之上,是口服降血糖藥物無法有效控制血糖時的優先治療選擇之一,基礎胰島素有中效胰島素NPH insulin與長效型胰島素類似物(long-acting insulin analogs包括insulin glargine及insulin detemir)。由於insulin glargine及insulin detemir使用筆型注射器注射,在學習與操作上較傳統胰島素空針簡易,且insulin glargine及insulin detemir在治療時發生低血糖的機會較NPH insulin低,有助於減少患者在使用胰島素治療時的一些障礙。因此,insulin glargine及insulin detemir在臨床使用上越來越普遍,本文目的爲針對長效型胰島素類似物做系統性的整理,方便醫師在臨床使用時的參考與應用。
Effective glycemic control plays an important role in preventing chronic complications of type 2 diabetes mellitus. Oral antidiabetic drugs (OADs) often are the mainstay of treatment. However, type 2 diabetes is a progressive illness which most patients experience a progressive deterioration in glycemic control, OADs also may not achieve or maintain glycemic control. In this setting, adding basal insulin to ongoing OADs is recommended as the next step therapy in the current consensus algorithm for the initiation and adjustment of therapy of the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Basal insulin include NPH insulin, insulin glargine and insulin detemir. Insulin glargine and insulin detemir have similar glycemic control, but less hypoglycemia than insulin NPH, and both are also available in pen devices to make their use more simper for patients. Therefore, insulin glargine and insulin detemir are getting more and more popular in the clinical use because they can help overcome some traditional barriers to insulin therapy. The article will review the current knowledge about long-acting insulin analogs in type 2 diabetes to help clinical health care providers in using basal insulin.