「Type2糖友提早打胰島素對是好是壞？」
意外發現2009年有許多有趣的文章
Early Insulin Use in Type 2 DiabetesWhat are the cons?
註：cons(in oppostion to against反對)
出處→S266 DIABETES CARE, VOLUME 32, SUPPLEMENT 2, NOVEMBER 2009
Early Insulin Treatment in Type 2 DiabetesWhat are the pros?
●反方的結論
CONCLUSIONS— Current evidence clearly indicates that achieving normoglycemia reduces the risk of microvascular complications and strongly suggests that this is probably true also for cardiovascular complications. There is no reliable evidence at the present time to indicate that the earlier use of insulin provides any additional longterm benefit beyond glycemic control. In addition, insulin therapy is associated with adverse effects including hypoglycemia,weight gain, and probably increased risk of colorectal cancer. However, treating to target remains the crucial goal. Insulin must be introduced in a timely fashion, that is, as soon as the oral antidiabetic agents fail to maintain A1C _7.0%.
目前的證據 清楚地表明，要實現正常的血糖濃度 降低微血管的風險 併發症和強烈 認為，這可能是真的也 心血管併發症。有在目前沒有可靠的證據 時間表明，早期使用 長期提供任何額外的胰島素 受益之外的血糖控制。 此外，胰島素治療是相關聯的 不利影響，包括低血糖，體重增加，並可能 增加大腸癌的危險。 然而，治療的目標仍然是 關鍵的目標。胰島素必須引入 及時，就是，只要儘快 口服降糖藥不能保持 糖化血紅蛋白？7.0％。
註：pros(in favor of贊成者)
出處→S270 DIABETES CARE, VOLUME 32, SUPPLEMENT 2, NOVEMBER 2009
●贊成的結論
CONCLUSIONS—In summary, aggressive and often temporary use of insulin therapy at disease onset in type 2 diabetes is associated with effective glycemic control with minimal weight gain and hypoglycemia. Early restitution of physiologic insulin secretion and glycemic control could be, in theory, followed by therapies to prolong maintenance of euglycemia, such as thiazolidinediones- (20)or glucagons-like peptide 1–based interventions (to date not clinically tested). A more timely and selective introduction of insulin replacement therapy, as β-cell function progresses, could facilitate the achievement and maintenance of euglycemia and thus reduce disease-associated complications.
總之，有進取心 並經常臨時使用胰島素 在發病治療2型 糖尿病是與有效的血糖 以最小的控制體重增加和 低血糖。早期恢復生理 胰島素分泌和血糖控制 可能是，在理論上，其次是 正常血糖的治療方法延長維修， 如TZD（20） 或胰高血糖素樣肽1為基礎的干預 （不臨床測試日期）。一 更加及時和有選擇的引進 胰島素替代療法，β細胞 功能的發展，可以促進 實現和維持正常血糖 從而減少疾病有關 併發症。
心得分享...
兩篇文章的引言同是用
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047–1053
這份標示於WHO網站
Background information
:: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030 [pdf 231kb]
研究報告作為開頭，顯示糖尿病正以超乎估計的速度，迅速成為全球的健康負擔。 預防、改善、延遲皆為當務之急。
兩肇皆同意應當好好控制血糖， 贊成提早使用胰島素的一方，以空腹血糖>115mg/dl及喪失第一階段的胰島素分泌越早處理越有機會能維持、改善、甚至恢復功能。反對提早使用的一方，則是採用相關的不良影響做為結論。
胰島素注射治療，無論提早與否，只要能達到最終目標─血糖控制延緩、預防減輕併發症最重要。
