详细记录  
题名:Clinical Evidence for the Earlier Initiation of Insulin Therapy in Type 2 Diabetes.
作者:OWENS DR;
来源:Diabetes Technol Ther. 2013 Jun 20. [ IF= 0.00 ] ]
URL :10.1089/dia.2013.0081
日期:20130702
摘要:Abstract The natural history of type 2 diabetes mellitus (T2DM) is a relentless
progression of beta-cell failure and dysregulation of beta-cell function with
increasing metabolic derangement. Insulin remains the only glucose-lowering
therapy that is efficacious throughout this continuum. However, the timing of
introduction and the choice of insulin therapy remain contentious because of the
heterogeneity of T2DM and the well-recognized behavioral and therapeutic
challenges associated with this mode of therapy. Nevertheless, the early
initiation of basal insulin has been shown to improve glycemic control and affect
long-term outcomes in people with T2DM and is a treatment strategy supported by
international guidelines as part of an individualized approach to chronic disease
management. The rationale for early initiation of insulin is based on evidence
demonstrating multifaceted benefits, including overcoming the glucotoxic effects
of hyperglycemia, thereby facilitating "beta-cell rest," and preserving beta-cell
mass and function, while also improving insulin sensitivity. Independent of its
effects on glycemic control, insulin possesses anti-inflammatory and antioxidant
properties that may help protect against endothelial dysfunction and damage
resulting in vascular disease. Insulin therapy and the achievement of good
glycemic control earlier in T2DM provide long-term protection to end organs via
"metabolic memory" regardless of subsequent treatments and degree of glycemic
control. This is evidenced from long-term observations continuing from trials
such as the United Kingdom Prospective Diabetes Study. As such, early initiation
of insulin therapy may not only help to avoid the effects of prolonged glycemic
burden, but may also positively alter the course of disease progression.

================  评  论  部  分=================

重要性:
分类:(参照 Faculty of 1000 的分类体系)


评语:

评论密码:   返回前页  [全部]