نظائر الأنسولين: الكثير من الضوضاء حول فوائد طفيفة

Insulin analogues: too much noise about small benefits

نظائر الأنسولين: الكثير من الضوضاء حول فوائد طفيفة

Andrea Siebenhofer-Kroitzsch, Karl Horvath, Johannes Plank. Insulin analogues: too much noise about small benefits. CMAJ. 2009 Feb 17; 180(4): 369–370.

نظائر الأنسولين: الكثير من الضوضاء حول فوائد طفيفة

لقد أكَّدت نتائج الدراسات الأكاديمية المحايدة (1-15) أن التحسُّن في السيطرة مستوى السكر في الدم وتقليل مخاطر هبوط السكر في الدم وتحسين نوعية الحياة التي تحققت مع استعمال نظائر الأنسولين مقارنة بالإنسولين البشري هي في أحسن الأحوال ثانوية أو ضئيلة وذات أهمية قابلة للنقاش سريريا. ويجب حصر استعمال نظائر الأنسولين لمرضى محدودين جدا مثل المصابين بهبوط السكر في الدم أثناء الليل. وعليه يجب أن تتركز الجهود على تقديم برامج تعليمية منظمة لمساعدة المرضى على معالجة مرض السكري وتحسين السيطرة على مستوى السكر في الدم.

1. Holman RR, Paul SK, Bethel MA, et al. 10-year follow-up of intensive glucose control in type 2 diabetes. N Engl J Med 2008;359:1577-89. [PubMed]

2. Nathan DM, Cleary PA, Backlund JY, et al. Intensive diabetes treatment and cardiovascular disease in patients with type 1 diabetes. N Engl J Med2005;353:2643-53. [PMC free article] [PubMed]

3. Singh SR, Ahmad F, Lal A, et al. Efficacy and safety of insulin analogues for the management of diabetes mellitus: a meta-analysis. CMAJ 2009;180:385-97. [PMC free article] [PubMed]

4. Siebenhofer A, Plank J, Berghold A, et al. Short acting insulin analogues versus regular human insulin in patients with diabetes mellitus. Cochrane Database Syst Rev 2006;(2):CD003287. [PubMed]

5. Horvath K, Jeitler K, Berghold A, et al. Long-acting insulin analogues versus NPH insulin (human isophane insulin) for type 2 diabetes mellitus. Cochrane Database Syst Rev 2007;(2):CD005613. [PubMed]

6. Rapid-acting insulin analogues in the treatment of diabetes mellitus type 1. Cologne (Germany): Institute for Quality and Efficiency in Health Care; 2005. Available: www.iqwig.de/download/A05-02_Executive_Summary_Rapid-acting_insulin_analogues_in_the_treatment_of_diabetes_mellitus_type_1.pdf(accessed 2009 Jan. 7).

7. Rayman G, Profozic V, Middle M. Insulin glulisine imparts effective glycaemic control in patients with type 2 diabetes. Diabetes Res Clin Pract2007;76:304-12. [PubMed]

8. Diabetes Control and Complications Trial Research Group. The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med1993;329:977-86. [PubMed]

9. Müller N, Schiel R, Osterbrink B, et al. Care and outcome in patients with diabetes mellitus type 1 and type 2 in specialized practice, diabetes specialized hospital and diabetes department of a regional general hospital in Germany 2005. Diabetologie Stoffwechsel 2008;3:41-50.

10. Heinemann L. Do insulin-treated diabetic patients use an injection-meal-interval in daily life? Diabet Med 1995;12:449-50. [PubMed]

11. Gale EA. A randomized, controlled trial comparing insulin lispr o with human soluble insulin in patients with type 1 diabetes on intensified insulin therapy. The UK Trial Group. Diabet Med 2000;17:209-14. [PubMed]

12. DAFNE Study Group. Training in flexible, intensive insulin management to enable dietary freedom in people with type 1 diabetes: dose adjustment for normal eating (DAFNE) randomised controlled trial. BMJ 2002;325:746. [PMC free article] [PubMed]

13. Pieber TR, Holler A, Siebenhofer A, et al. Evaluation of a structured teaching and treatment programme for type 2 diabetes in general practice in a rural area of Austria. Diabet Med 1995;12:349-54. [PubMed]

14. Plank J, Kohler G, Rakovac I, et al. Long-term evaluation of a structured outpatient education programme for intensified insulin therapy in patients with type 1 diabetes: a 12-year follow-up. Diabetologia 2004;47:1370-5. [PubMed]

15. Sämann A, Mühlhauser I, Bender R, et al. Glycaemic control and severe hypoglycaemia following training in flexible, intensive insulin therapy to enable dietary freedom in people with type 1 diabetes: a prospective implementation study. Diabetologia 2005;48:1965-70. [PubMed]