Insulin

消化

关键词消化 临床研究术语 药理学

词汇介绍

拓展阅读

解析

insulin 英 [ˈɪnsjəlɪn] 美 [ˈɪnsəlɪn]

释义   n. [生化][药] 胰岛素

例句   Therefore, insulin resistance alone can not be the determining pathogenic factor in T2DM. 因此,胰岛素抵抗本身不能成为T2DM的决定因素。


概述

胰岛素是由胰脏内的胰岛β细胞受内源性或外源性物质如葡萄糖、乳糖、核糖、精氨酸、胰高血糖素等的刺激而分泌的一种蛋白质激素。胰岛β细胞中储备胰岛素约200U,每天分泌约40U。空腹时,血浆胰岛素浓度是5~15μU/mL。进餐后血浆胰岛素水平可增加5~10倍。胰岛素是机体内唯一降低血糖的激素,同时促进糖原、脂肪、蛋白质合成。外源性胰岛素主要用来治疗糖尿病。 结构胰岛素由A、B两条肽链组成。人胰岛素(Insulin Human) A链有11种21个氨基酸,B链有15种30个氨基酸

Use and Discontinuation of Insulin Treatment Among Adults Aged 75 to 79 Years With Type 2 Diabetes复制标题

75 ~ 79岁2型糖尿病患者使用和停止胰岛素治疗

发表时间:2019-09-23

影响因子:20.8

作者: Jonathan Z Weiner

期刊:JAMA Internal Medicine

Existing guidelines recommend individualizing glycemic targets based on health status but do not make specific recommendations about insulin use. We studied the prevalence of insulin use and discontinuation among a cohort of 75-yearolds with type 2 diabetes to test the hypothesis that older adults with poor health would be less likely to use insulin and bemore likely to discontinue insulin over time. We found that nearly 1 in 5 individuals were receiving insulin therapy at age 75 years. Insulin use was most prevalent among those in poor health, whereas subsequent insulin discontinuation after age 75 years was most likely in healthier patients, even after accounting for level of glycemic control. The results of this study suggest that neither prevalent insulin use nor subsequent insulin discontinuation among older patients is closely aligned with current recommendations to incorporate health status (in conjunction with life expectancy  and patient preferences) when making treatment decisions. These patterns remained evident even when accounting for level of glycemic control. For example, we would expect to find less insulin discontinuation among relatively healthy patients with poor glycemic control (HbA1c≥8.5%) relative to less healthy patients because these healthier patients are more likely to realize long-term clinical benefit with the tighter control that would be expected from continuing insulin therapy. However, Figure 3B demonstrates that discontinuation follows the opposite pattern: patients with poor health are least likely to discontinue insulin.

译文

现有指南建议根据健康状况对血糖目标进行个性化设置,但不对胰岛素的使用提出具体建议。我们研究了一组75岁的2型糖尿病患者中胰岛素使用和停用的普遍性,以检验以下假设:健康状况较差的老年人使用胰岛素的可能性较小,并且随着时间的推移停用胰岛素的可能性更大。我们发现有五分之一的人在75岁时接受胰岛素治疗。在健康状况不佳的人群中,胰岛素的使用最为普遍,而更健康的患者中,即使考虑了血糖控制水平,最有可能在75岁以后停用胰岛素。这项研究的结果表明,老年患者中普遍使用胰岛素或随后停用胰岛素均与当前在制定治疗决策时纳入健康状况(以及预期寿命和患者偏好)的建议紧密相关。即使考虑到血糖控制水平,这些模式仍然明显。例如,我们希望在血糖控制不佳(HbA1c≥8.5%)的相对健康的患者中发现相对于健康状况较差的患者较少的胰岛素停药,因为这些更健康的患者通过更严格的控制更可能实现长期临床获益可以从持续的胰岛素治疗中获得期望但是,图3B显示停药遵循相反的模式:健康状况不佳的患者停药的可能性最小。