Value of early insulin initiation
Dr. Fahrettin Kelestimur
Kelestimur教授以英国前瞻性糖尿病研究（UKPDS）所示单药治疗难以持久控制2型糖尿病患者血糖为依据，强调了糖尿病进行性进展的特点，而其进展性又与β细胞功能衰减密切相关。关注β细胞功能是糖尿病治疗中不可忽视的方面。阿尔瓦森（Alvarsson）等的研究已证实，与口服降糖药（格列本脲）相比，早期使用胰岛素治疗不仅可以改善血糖控制，而且可以保护β细胞功能。
Kelestimur教授还指出，高血糖代谢记忆效应的存在也强调了早期干预的重要性。早期使用胰岛素将血糖控制良好，可使患者持续获益。勒罗伊斯（LeRoith）等的研究显示，与常规治疗相比，胰岛素治疗5年血糖控制好且并发症进展率低，而且即使研究终止，两组血糖水平逐渐接近，胰岛素组在并发症方面的获益仍继续扩大。同样，UKPDS后续随访也证实了早期胰岛素强化干预减轻代谢记忆效应的作用。
Landmark trial data provided by the UKPDS shows that glycaemic control in patients with type 2 diabetes worsens with continued monotherapy. It is common for many type 2 diabetes patients to progress from treatment with non-pharmacological measures (diet and exercise alone) to gradually more intensive treatment. Most patients ultimately require insulin, either with or without combination oral therapy.
However, physicians commonly prescribe a second and even a third oral antidiabetic drug and delay insulin initiation despite poor glycaemic control. Throughout this session Professor Kelestimur will review insulin resistance and how beta-cell dysfunction ultimately determines the onset of hyperglycaemia and disease progression. Further,the theory of metabolic memory and insulin therapy as having a beneficial role in the prevention of diabetes related complications in type 2 diabetes will be discussed.
Fahrettin Kelestimur教授：早期启动胰岛素治疗的重要性
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