Wysham Carol H, Campos Carlos, Kruger Davida
Rockwood Center for Diabetes and Endocrinology, Spokane, WA.
Department of Family Medicine, UT Health San Antonio, San Antonio, TX.
Clin Diabetes. 2018 Apr;36(2):149-159. doi: 10.2337/cd17-0064.
Novel co-formulations of basal insulin analogs and glucagon-like peptide-1 (GLP-1) receptor agonists have provided new options for patients with type 2 diabetes who are not reaching recommended glycemic targets. The components of currently available co-formulations (insulin degludec/ liraglutide [IDegLira,] and insulin glargine U100/lixisenatide [iGlarLixi]) act synergistically to address multiple pathophysiologic defects while minimizing the side effects associated with either component when used alone. In Europe, these products are approved for use in patients on regimens of one or more oral antidiabetic drugs; in the United States, they are indicated for use as an adjunct to diet and exercise in patients with type 2 diabetes inadequately controlled with either basal insulin or their respective GLP-1 receptor agonist component. This article reviews key clinical trials in which these products were initiated in insulin-naive patients and describes how they can be safely and effectively titrated in clinical practice.
基础胰岛素类似物与胰高血糖素样肽-1(GLP-1)受体激动剂的新型复方制剂,为未达到推荐血糖目标的2型糖尿病患者提供了新的选择。目前可用的复方制剂(德谷胰岛素/利拉鲁肽[IDegLira]和甘精胰岛素U100/利司那肽[iGlarLixi])的成分具有协同作用,可解决多种病理生理缺陷,同时将单独使用任一成分时的副作用降至最低。在欧洲,这些产品被批准用于接受一种或多种口服抗糖尿病药物治疗的患者;在美国,它们被指定用于饮食和运动的辅助治疗,适用于使用基础胰岛素或其各自的GLP-1受体激动剂成分控制不佳的2型糖尿病患者。本文回顾了在初治胰岛素患者中启动这些产品的关键临床试验,并描述了如何在临床实践中对其进行安全有效的滴定。