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首页> 外文期刊>Expert opinion on pharmacotherapy >Insulin glargine and its place in the treatment of Types 1 and 2 diabetes mellitus.
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Insulin glargine and its place in the treatment of Types 1 and 2 diabetes mellitus.

机译：甘精胰岛素及其在1型和2型糖尿病治疗中的作用。

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Insulin treatment in Type 1 and Type 2 diabetes has come a long way since its discovery by Banting and Best in 1922. Early insulin therapy was life-saving, but was associated with practical problems and had side effects such as lipoatrophy. Initial modifications of insulin structure produced several classes of insulins with varying pharmacokinetics, but did not sufficiently mimic physiological insulin release. Novel long- and short-acting insulin analogues, the so-called 'designer insulins', developed through genetic engineering in the 1990s, paved the way for more physiological insulin therapy, which was theoretically less problematic in terms of hypoglycaemia and patient satisfaction. Insulin glargine (glargine) was the first DNA-recombinant long-acting insulin analogue. The replacement of asparagine with glycine and the addition of two arginine molecules in the molecular structure results in modified pharmacokinetics. Consequently, glargine has a longer, often 24-h profile, which is described as 'peakless' compared with other insulins such as neutral protamine Hagedorn insulin (NPH) and insulin ultralente. Since its launch, the use of glargine in Type 1 and Type 2 diabetes has been extensively reviewed to determine its place in the current insulin market. A potential advantage of glargine seems to be a lower risk of hypoglycaemia, particularly at night. The UK National Institute of Clinical Excellence has recommended that glargine is a treatment option for people with Type 1 diabetes. In Type 2 diabetes, it has been advised that glargine only be considered for: those who require assistance to administer insulin injections; those whose lifestyle is restricted significantly by recurrent symptomatic hypoglycaemic episodes; or those who would otherwise need twice-daily basal insulin injections in combination with oral glucose-lowering drugs.
机译：自1922年Banting和Best发明胰岛素治疗1型和2型糖尿病以来，已经走了很长一段路。早期的胰岛素治疗可挽救生命，但存在实际问题，并具有诸如脂肪萎缩等副作用。胰岛素结构的最初修饰产生了几类具有不同药代动力学的胰岛素，但没有充分模拟生理胰岛素的释放。 1990年代通过基因工程开发的新型长效和短效胰岛素类似物，即所谓的“设计胰岛素”，为更多的生理胰岛素疗法铺平了道路，从理论上讲，低血糖和患者满意度方面的问题较少。甘精胰岛素（甘精胰岛素）是第一个重组DNA的长效胰岛素类似物。用甘氨酸替代天冬酰胺并在分子结构中添加两个精氨酸分子导致修饰的药代动力学。因此，甘精胰岛素具有更长的，通常为24小时的特性曲线，与其他胰岛素（例如中性鱼精蛋白哈格多恩胰岛素（NPH）和超高效胰岛素）相比，被描述为“无峰值”。自推出以来，甘精胰岛素在1型和2型糖尿病中的使用已得到广泛审查，以确定其在当前胰岛素市场中的地位。甘精胰岛素的潜在优势似乎是降低低血糖的风险，尤其是在夜间。英国国家临床卓越研究所建议，甘精胰岛素是1型糖尿病患者的治疗选择。在2型糖尿病中，建议仅将甘精胰岛素用于以下人群：那些需要协助注射胰岛素的人;反复出现症状性低血糖发作严重限制其生活方式的人群;或否则需要每天两次注射基础胰岛素和口服降糖药的患者。

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