Инсулинотерапия – персонализированный подход к управлению гликемией при сахарном диабете

Демидова Т.Ю., Титова В.В. Инсулинотерапия – персонализированный подход к управлению гликемией при сахарном диабете. Терапевтический архив. 2020; 92 (12): 201–206. DOI: 10.26442/00403660.2020.12.200449

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Demidova T.Yu., Titova V.V. Insulin therapy is a personalized approach to glycemic management in diabetes. Therapeutic Archive. 2020; 92 (12): 201–206. DOI: 10.26442/00403660.2020.12.200449

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Аннотация

Сахарный диабет (СД) 2-го типа характеризуется хронической гипергликемией и различной степенью инсулинорезистентности и инсулинопении. Достижение целевого гликемического контроля пациентов с СД важно для снижения риска развития поздних осложнений, и многим пациентам с СД 2-го типа для поддержания адекватного гликемического контроля в конечном итоге требуется терапия инсулином. Своевременное назначение инсулина может предотвратить прогрессирование СД, уменьшить развитие осложнений и иметь менее выраженные побочные эффекты. Базальный инсулин является предпочтительным вариантом в большинстве случаев недостижения целевого гликемического контроля. Однако в клинической практике существует значительная терапевтическая инерция как в отношении инициирования инсулинотерапии, так и титрации дозировки базального инсулина. Более длительная продолжительность действия, сниженная вариабельность гликемии и более низкий риск гипогликемии, наблюдаемые при использовании аналогов базального инсулина последнего поколения по сравнению с предыдущим, упрощают титрацию и могут повысить приверженность пациентов лечению.

Ключевые слова: сахарный диабет, базальный инсулин, гликемический контроль, гипогликемия, аналоги инсулина, инсулинотерапия.

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Type 2 diabetes is characterized by chronic hyperglycemia and varying degrees of insulin resistance and insulinopenia. Achieving targeted glycemic control in diabetic patients is important to reduce the risk of late complications, and many patients with type 2 diabetes ultimately require insulin therapy to maintain adequate glycemic control. Timely administration of insulin can prevent the progression of diabetes, reduce the development of complications, and have fewer side effects. Basal insulin is the preferred option in most cases when glycemic control is not achieved. However, there is considerable therapeutic inertia in clinical practice, both with respect to initiation of insulin therapy and titration of the basal insulin dose. The longer duration of action, reduced glucose variability and a lower risk of hypoglycemia seen with the latest generation of basal insulin analogs compared to the previous generation simplify titration and may increase patient compliance.

Keywords: diabetes mellitus, basal insulin, glycemic control, hypoglycemia, insulin analogs, insulin therapy.

Авторы

Т.Ю. Демидова, В.В. Титова

ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России, Москва, Россия

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T.Yu. Demidova, V.V. Titova

Pirogov Russian National Research Medical University, Moscow, Russia

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19. Vargas-Uricoechea H. Efficacy and Safety of Insulin Glargine 300 U/mL versus 100 U/mL in Diabetes Mellitus: A Comprehensive Review of the Literature. J Diabetes Res. 2018; p. 1-28. doi: 10.1155/2018/2052101
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21. Khunti K, Giorgino F, Berard L, et al. The importance of the initial period of basal insulin titration in people with diabetes. Diabetes, Obesity And Metabolism. 2020;22(5):722-33. doi: 10.1111/dom.13946
22. Russell-Jones D, Dauchy A, Delgado E, et al. Take Control: A randomized trial evaluating the efficacy and safety of self- versus physician-managed titration of insulin glargine 300 U/mL in patients with uncontrolled type 2 diabetes. Diabetes, Obes Metab. 2019;21(7):1615-24. doi: 10.1111/dom.13697
23. Yale J, Berard L, Groleau M, et al. TITRATION: A Randomized Study to Assess 2 Treatment Algorithms with New Insulin Glargine 300 units/mL. Canad J Diabetes. 2017;41(5):478-84. doi: 10.1016/j.jcjd.2017.06.007
24. Yazdanpanah S, Rabiee M, Tahriri M, et al. Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: A comprehensive review. Critical Rev Clin Lab Sci. 2017;54(4):219-32. doi: 10.1080/10408363.2017.129968425
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27. Sun B, He F, Gao Y, et al. Prognostic impact of visit-to-visit glycemic variability on the risks of major adverse cardiovascular outcomes and hypoglycemia in patients with different glycemic control and type 2 diabetes. Endocrine. 2019;64(3):536-43. doi: 10.1007/s12020-019-01893-1
28. Hawkes C, Willi S, Murphy K. A structured 1-year education program for children with newly diagnosed type 1 diabetes improves early glycemic control. Pediatric Diabetes. 2019;20(4):460-7. doi: 10.1111/pedi.12849
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34. Sobngwi E, Enoru S, Ashuntantang G, et al. Day-to-Day Variation of Insulin Requirements of Patients With Type 2 Diabetes and End-Stage Renal Disease Undergoing Maintenance Hemodialysis. Diabetes Care. 2010;33(7):1409-12. doi: 10.2337/dc09-2176
35. Singhsakul A, Supasyndh O, Satirapoj B. Effectiveness of Dose Adjustment of Insulin in Type 2 Diabetes among Hemodialysis Patients with End-Stage Renal Disease: A Randomized Crossover Study. J Diabetes Res. 2019;1-5. doi: 10.1155/2019/6923543
36. Haluzík M, Cheng A, Müller-Wieland D, et al. Differential glycaemic control with basal insulin glargine 300 U/mL versus degludec 100 U/mL according to kidney function in type 2 diabetes: A subanalysis from the BRIGHT trial. Diabetes, Obes Metab. 2020;22(8);1369-77. doi: 10.1111/dom.14043

________________________________________________

1. [Antsiferov MB, Demidov NA, Kalashnikova MF, et al. The dynamics of the main epidemiological indicators among living in Moscow patients with diabetes mellitus (2013–2018). Diabetes Mellitus. 2020;23(2):113-24 (In Russ.)]. doi: 10.14341/dm11374
2. [Mel'nikova OG, et al. Dostizhenie individual'nyh celevyh pokazatelej glikemicheskogo kontrolja u bol'nyh saharnym diabetom 2 tipa na insulinoterapii v ramkah strukturirovannoj programmy dlitel'nogo nabljudenija. 2018;
p. 430-1 (In Russ.)].
3. Bikbov M, Fayzrakhmanov R, Kazakbaeva G, et al. Prevalence, awareness and control of diabetes in Russia: The Ural Eye and Medical Study on adults aged 40+ years. PLOS ONE. 2019;14(4):e0215636. doi: 10.1371/journal.pone.0215636
4. Dong Q, Huang J, Liu S, et al. A survey on glycemic control rate of type 2 diabetes mellitus with different therapies and patients’ satisfaction in China. Patient Preference Adherence. 2019;13:1303-10. doi: 10.2147/ppa.s198908
5. Andreozzi F, Candido R, Corrao S, et al. Clinical inertia is the enemy of therapeutic success in the management of diabetes and its complications: a narrative literature review. Diabetol Metab Syndrome. 2020;12(1). doi: 10.1186/s13098-020-00559-7
6. Dedov II, Shestakova MV, Vikulova OK. Epidemiology of diabetes mellitus in Russian Federation: clinical and statistical report according to the federal diabetes registry. Diabetes Mellitus. 2017;20(1):13-41 (In Russ.)]. doi: 10.14341/dm8664
7. Berard L, Antonishyn N, Arcudi K, et al. Insulin Matters: A Practical Approach to Basal Insulin Management in Type 2 Diabetes. Diabetes Therapy. 2018;9(2):501-19. doi: 10.1007/s13300-018-0375-7
8. Davies M, D’Alessio D, Fradkin J, et al. Management of hyperglycaemia in type 2 diabetes, 2018. A consensus report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD). Diabetologia. 2018;61(12):2461-98. doi: 10.1007/s00125-018-4729-5
9. Hanefeld M, Fleischmann H, Siegmund T, Seufert J. Rationale for Timely Insulin Therapy in Type 2 Diabetes Within the Framework of Individualised Treatment: 2020 Update. Diabetes Therapy. 2020;11(8):1645-66. doi: 10.1007/s13300-020-00855-5
10. [Standards of specialized diabetes care. Edited by Dedov II, Shestakova MV, Mayorov AYu. 9th edition. Moscow, 2019 (In Russ.)]. doi: 10.14341/DM221S1
11. [Kalyagin AN, et al. Current opportunities of pharmacotherapy diabetes type 2. Almanac of Nursing. 2018;11(1) (In Russ.)].
12. Mashitisho M, Mashitisho B. Early insulin therapy in patients with type 2 diabetes mellitus. J Endocrinol, Metab Diabetes South Africa. 2016;21(1):13-5. doi: 10.1080/16089677.2016.1160539
13. Polonsky WH, et al. Initiating insulin: How to help people with type 2 diabetes start and continue insulin successfully. Int J Clin Pract. 2017;71(8).
14. [Gendeleka GF, Gendeleka AN. Insulin therapy of type 2 diabetes mellitus. International journal of endocrinology. 2020;16(1):63-8 (In Russ.)].
doi: 10.22141/2224-0721.16.1.2020.199130
15. Ji L, Zhang P, Zhu D, et al. Comparative effectiveness and safety of different basal insulins in a real-world setting. Diabetes, Obes Metab. 2017;19(8):1116-26. doi: 10.1111/dom.12920
16. Becker RHA, Nowotny I, Teichert L, et al. Low within- and between-day variability in exposure to new insulin glargine 300 U/ml. Diabetes, Obesity and Metabolism. 2015;17(3):261-7. doi: 10.1111/dom.12416
17. Becker RHA, Dahmen R, Bergmann K, et al. New Insulin Glargine 300 units{middle dot}mL-1 Provides a More Even Activity Profile and Prolonged Glycemic Control at Steady State Compared With Insulin Glargine 100 units{middle dot}mL-1. Diabetes Care. 2014. doi: 10.2337/dc14-0006
18. Ritzel R, Harris SB, Baron H, et al. A Randomized Controlled Trial Comparing Efficacy and Safety of Insulin Glargine 300 Units/mL Versus 100 Units/mL in Older People With Type 2 Diabetes: Results From the SENIOR Study. Diabetes Care. 2018;41(8):1672–80. doi: 10.2337/dc18-0168
19. Vargas-Uricoechea H. Efficacy and Safety of Insulin Glargine 300 U/mL versus 100 U/mL in Diabetes Mellitus: A Comprehensive Review of the Literature. J Diabetes Res. 2018; p. 1-28. doi: 10.1155/2018/2052101
20. Yale J-F, Aroda VR, Charbonnel B, et al. Glycaemic control and hypoglycaemia risk with insulin glargine 300 U/mL versus glargine 100 U/mL: A patient-level meta-analysis examining older and younger adults with type 2 diabetes. Diabetes Metab. 2020;46(2):110-8. doi: 10.1016/j.diabet.2018.10.002
21. Khunti K, Giorgino F, Berard L, et al. The importance of the initial period of basal insulin titration in people with diabetes. Diabetes, Obesity And Metabolism. 2020;22(5):722-33. doi: 10.1111/dom.13946
22. Russell-Jones D, Dauchy A, Delgado E, et al. Take Control: A randomized trial evaluating the efficacy and safety of self- versus physician-managed titration of insulin glargine 300 U/mL in patients with uncontrolled type 2 diabetes. Diabetes, Obes Metab. 2019;21(7):1615-24. doi: 10.1111/dom.13697
23. Yale J, Berard L, Groleau M, et al. TITRATION: A Randomized Study to Assess 2 Treatment Algorithms with New Insulin Glargine 300 units/mL. Canad J Diabetes. 2017;41(5):478-84. doi: 10.1016/j.jcjd.2017.06.007
24. Yazdanpanah S, Rabiee M, Tahriri M, et al. Evaluation of glycated albumin (GA) and GA/HbA1c ratio for diagnosis of diabetes and glycemic control: A comprehensive review. Critical Rev Clin Lab Sci. 2017;54(4):219-32. doi: 10.1080/10408363.2017.129968425
25. Standards of Medical Care in Diabetes – 2020 Abridged for Primary Care Providers. Clinical Diabetes. 2019;38(1):10-38. doi: 10.2337/cd20-as01
26. Laiteerapong N, Ham S, Huang E, Karter A. Response to Comment on Laiteerapong et al. The Legacy Effect in Type 2 Diabetes: Impact of Early Glycemic Control on Future Complications (The Diabetes & Aging Study). Diabetes Care. 2019;42:416-26. doi: 10.2337/dci18-0036
27. Sun B, He F, Gao Y, et al. Prognostic impact of visit-to-visit glycemic variability on the risks of major adverse cardiovascular outcomes and hypoglycemia in patients with different glycemic control and type 2 diabetes. Endocrine. 2019;64(3):536-43. doi: 10.1007/s12020-019-01893-1
28. Hawkes C, Willi S, Murphy K. A structured 1-year education program for children with newly diagnosed type 1 diabetes improves early glycemic control. Pediatric Diabetes. 2019;20(4):460-7. doi: 10.1111/pedi.12849
29. Kisokanth G, Indrakumar J, Prathapan S, et al. A preliminary study on diabetes self-management education and glycemic control among patients with diabetes mellitus. J Nurs Educat Pract. 2019;9(9):98. doi:10.5430/jnep.v9n9p98
30. Mohammed ER, Ahmed NM, Elkhalik EFA. Effectiveness of structured teaching program on improvement of diabetic patient's health information, treatment adherence and glycemic control. Int J Nurs Didact. 2020;10(5):1-14. doi: 10.15520/ijnd.v10i05.2904
31. Pacheco A, Sande-Lee S, Sandoval R, et al. Effects of a structured education program on glycemic control in type 1 diabetes. Arch Endocrinol Metab. 2017;61(6):534-41. doi: 10.1590/2359-3997000000278
32. Bala C, Rusu A, Moise M, Roman G. The Impact of Structured Diabetes Education on Glycemic Control in Patients with Type 2 Diabetes at Initiation of Basal Insulin – The Basal-EDUC-RO Study: A Randomized Prospective Study. Rom J Diabetes Nutr Metab Dis. 2019;26(2):185-98. doi: 10.2478/rjdnmd-2019-0020
33. Clarke WL, Kovatchev B. Chapter 8 – Accuracy of CGM systems. Glucose Monitoring Devices. Ed. by C. Fabris, B. Kovatchev. Academic Press, 2020; p. 159-71.
34. Sobngwi E, Enoru S, Ashuntantang G, et al. Day-to-Day Variation of Insulin Requirements of Patients With Type 2 Diabetes and End-Stage Renal Disease Undergoing Maintenance Hemodialysis. Diabetes Care. 2010;33(7):1409-12. doi: 10.2337/dc09-2176
35. Singhsakul A, Supasyndh O, Satirapoj B. Effectiveness of Dose Adjustment of Insulin in Type 2 Diabetes among Hemodialysis Patients with End-Stage Renal Disease: A Randomized Crossover Study. J Diabetes Res. 2019;1-5. doi: 10.1155/2019/6923543
36. Haluzík M, Cheng A, Müller-Wieland D, et al. Differential glycaemic control with basal insulin glargine 300 U/mL versus degludec 100 U/mL according to kidney function in type 2 diabetes: A subanalysis from the BRIGHT trial. Diabetes, Obes Metab. 2020;22(8);1369-77. doi: 10.1111/dom.14043

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