门诊2型糖尿病患者胰岛素应用共识

J Assoc Physicians India.2017 Feb;65(2):17-30.

ConsensusonInsulinDoseandTitrationAlgorithmsinAmbulatoryCareofType2DiabetesinIndia.

印度门诊2型糖尿病患者胰岛素应用共识

Abstract

INSTRUCTION:

Insulinis the oldest of the currently available treatment options inType2diabetesmellitus(T2DM)and is considered as the most effective glucose lowering agent.Despite this,decision on startinginsulintherapy is often delayed inIndiaas well as worldwide due to various barriers at both patient and physician levels.Appropriateinsulindosing andtitrationis also critical to the successful achievement of tight glycaemic control.

胰岛素是最古老的2型糖尿病（T2DM）治疗药物，是目前最有效的降糖药物。尽管如此，在印度和世界各地由于患者和医生水平的各种原因，起始胰岛素治疗往往被推迟。适当的胰岛素剂量和调整也是严格控制血糖达标的关键。

OBJECTIVE:

To provide simple and easily implementable guidelines to primarycarephysicians on appropriateinsulindosing andtitrationof variousinsulinregimens for both initiation and intensification.

为基层医生提供简单和实用的各种胰岛素起始和强化治疗方案的胰岛素起始和剂量调整指南。

METHODOLOGY:

Eachinsulinregimen(once daily[OD]basal,OD,twice daily and thrice daily premixed,basal-plus and basal-bolus)was presented and evaluated for dosing andtitrationbased on established guidelines,data from approved pack inserts,and published scientific literature.These evaluations were then factored into the national context based on the expert committee representatives patient-physician experience in their clinical practice and common therapeutic practices followed inIndia.

根据目前指南、药物说明书和已发表的科学文献数据，评估了各种胰岛素治疗方案（每日一次基础；每日一次、每日两次、每日三次预混；基础-追加和基础-餐时）的起始和剂量调整。结合这些评估并考虑全国专家委员会代表的经验，形成印度国家临床实践和治疗共识。

RESULTS:

Recommendations for dosing andtitrationof basal,basal-plus,premixed and basal-bolus insulins were developed.The key recommendations are thatinsulindoses can be adjusted once or twice weekly;adjustment can be based on lowest/mean of three recent self-monitoring of plasma glucose pre-meal/fasting plasma glucose(FPG)values.Thetitrationshould be based on FPG or pre-meal value of 80-130 mg/dL and thedoseshould be reduced by 10-20%for patients reporting hypoglycaemia(<70mg/dL).

制定了基础、基础-追加、预混和基础-餐时胰岛素起始和剂量调整建议。主要推荐意见是：胰岛素剂量可以每周调整1~2次；可根据最近3次餐前/空腹自我血糖监测的最低/平均血糖值调整剂量。一般以空腹血糖或餐前血糖值4.4~7.2 mmol/L为目标调整剂量，如果患者出现低血糖（<3.9 mmol/L），应减少剂量10%~20%。

CONCLUSIONS:

Theconsensusbased recommendations mentioned in this paper will be a useful reference tool for healthcarepractitioners,to initiate,optimise and intensifyinsulintherapy and to successfully achieve optimal glucose control.

本文中共识基础上的建议对临床医生起始、优化和强化胰岛素治疗并控制血糖达标将是一个重要的参考。

PMID:28457028