Intensification options and guidelines
Dr. Robert Ligthelm
Medical Director, EHM-Hoofddorp
Rotterdam, The Netherlands
对已接受胰岛素治疗的患者，随着其病情的进展，仍会出现血糖控制不佳，这时需要强化胰岛素治疗。Ligthelm教授指出，对于强化胰岛素治疗策略的选择，需要考虑患者意愿和低血糖风险等多重因素。当使用预混或基础胰岛素控糖效果不佳时，使用预混胰岛素类似物（如门冬胰岛素30）是简单、有效的方法，而且可每日3次使用。
目前，关于预混胰岛素强化治疗方案和剂量的相关推荐有限，近期发表于《国际临床实践杂志》（Int J Clin Pract）的共识提供了较简单的门冬胰岛素30强化治疗方案，包括从每日1次或2次门冬胰岛素30治疗转至每日2次或3次门冬胰岛素30治疗，即从初始到强化均为门冬胰岛素30的简单转换，以及从每日1次或2次基础胰岛素治疗转至每日2次门冬胰岛素30治疗，具有较好的临床参考价值。
而且，Ligthelm教授指出，使用门冬胰岛素30作为强化治疗有以下优势。首先，与人胰岛素30相比，门冬胰岛素30降糖更符合生理特点；其次，门冬胰岛素30剂量调整方便，每日使用2次可有效降糖，且可增至每日3次使用，同时餐时注射方便；最后，门冬胰岛素30可同时降低FPG和PPG，每日1次使用与基础胰岛素类似物相比，可更好地控制HbA1c和PPG。
After successfully initiating and optimising insulin, modification of treatment by adding or changing therapy to achieve glycaemic targets is often required. However, this must be carefully moderated by patient’s willingness and the risk associated with hypoglycaemia.
Basal and premix insulins are commonly prescribed as first-line therapies for patients failing to maintain glycaemic control on oral therapy. However, when control with these insulins begins to fail, a premix analogue such as NovoMix® 30 is a simple and effective tool for intensification as being the only premix analogue which has been approved to be injected up to three-times daily. Currently, international recommendations for intensification of insulin therapy using premix analogues are limited and specific guidance on dosing is not available for many circumstances. As such, Dr Ligthelm will review the recently published consensus statement in the International Journal of Clinical Practice (2009) which provides simplified algorithms for intensifying insulin therapy with NovoMix® 30.
Robert Ligthelm教授：指南与强化治疗的选择
查看分页PPT： http://meeting.dxy.cn/2009asia_summit/article/i9913.html
