在1型糖尿病的管理中使用非胰岛素疗法
Zeb I Saeed1, Jayachidambaram Ambalavanan2, Melanie Natasha Rayan3
1Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts.
概括
类似葡萄糖-1受体激动剂 (GLP-1RAs) 和-葡萄糖共同载体抑制剂 (SGLTi) 显示出对1型糖尿病 (T1D) 管理的前景. GLP-1RAs在HbA1c,体重和胰岛素降低方面提供了显著的好处,而SGLTi也显示出有效性,但增加了糖尿病酸症的风险.
科学领域:
- 内分泌学 在内分泌学.
- 代谢疾病 代谢疾病
- 药理学 药理学是指药理学的学科.
背景情况:
- 增加双重糖尿病的患病率 (T1D患者的T2D特征).
- 对T1D管理的非胰岛素疗法越来越感兴趣.
- 需要改善血糖控制,体重控制和降低T1D的心血管风险.
研究的目的:
- 审查有关T1D非胰岛素治疗的当前文献.
- 为使用这些疗法提供临床指导.
- 评估各种非胰岛素药物的T1D疗效和安全性.
主要方法:
- 来自PubMed. 的51个随机临床试验的叙事综述.
- 研究了SGLTi,GLP-1RA,甲福明,DPP-4抑制剂,普拉姆林,克里和组合疗法.
- 结果包括HbA1c,体重,胰岛素剂量,心血管标志物和安全性.
主要成果:
- GLP-1RAs和SGLTi显示出显著的HbA1c降低 (高达0.7%和0.5%).
- GLP-1RAs降低了胰岛素TDD (18.5%) 和体重 (9.3%);SGLTi降低了胰岛素TDD (15.3%) 和体重 (5.3%).
- SGLTi显示糖尿病酸性酸症的风险高2-5倍;其他药物缺乏持续的血糖有效性.
结论:
- GLP-1RA疗法显示出作为T1D辅助治疗的巨大潜力.
- SGLTi可能是有益的,但需要进一步的研究来减轻糖尿病酸性脂肪酸症的风险.
- 对于每周的GLP-1RA及其在T1D中的心脏脏益处的有效性试验是合理的.
相关概念视频
Diabetes: Management and Pharmacotherapy
408
The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
408
Diabetes Mellitus: Overview and Type I Subtype
3.3K
Diabetes mellitus is a chronic metabolic disorder characterized by high blood glucose levels due to inadequate insulin production, insulin resistance, or both. The condition affects millions worldwide and can significantly impact their health and quality of life.
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
Type 1 diabetes is an autoimmune disease in which the immune system mistakenly attacks and destroys the insulin-producing beta cells in the pancreas. As a result, the body is unable to produce sufficient insulin, and individuals with...
3.3K
Insulin: Dosing Regimen and Adverse Effects
265
Insulin-replacement therapy usually includes both long-acting insulin (basal) and short-acting insulin (to cater to postprandial needs). In a diverse group of type 1 diabetes patients, the average daily insulin dose is typically 0.5-0.7 units/kg body weight. However, obese patients and pubertal adolescents may need more due to insulin resistance.
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
The basal dose constitutes about 40%-50% of the total daily dose, with the rest as premeal insulin. The mealtime insulin dose should mirror...
265
Diabetes Mellitus: Type 2 and Gestational
3.0K
Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...
3.0K
Glucagon-like Receptor Agonists
431
Incretins include glucagon-like peptide-1 (GLP-1) and glucose-dependent insulinotropic polypeptide (GIP), which stimulate insulin secretion post-meals. In type 2 diabetes, GIP's efficacy is reduced, making GLP-1 a viable drug target. GIP originates from preproGIP.
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
GLP-1, when administered in high doses intravenously, triggers insulin secretion, inhibits glucagon release, slows gastric emptying, reduces food intake, and restores normal insulin secretion. However, its rapid inactivation by...
431
Insulin Formulations: Types and Delivery
275
Insulin preparations are categorized by their duration of action into short-acting and long-acting types. Two strategies are used to modify insulin's absorption and pharmacokinetic profile: slowing the absorption post-subcutaneous injection, or altering human insulin's amino acid sequence or protein structure. These changes retain the insulin's ability to bind to the insulin receptor, but alter its behavior in solution or after injection.
Short-acting insulins are divided into...
Short-acting insulins are divided into...
275


