从糖尿病营养治疗策略变迁寻找适合中国患者的胰岛素治疗起始方案

Strategy Evolution of Medical Nutritional Therapy on Diabetes: New Perspective to Optimize the Insulin Initiation Appropriate to Chinese Patients with Diabetes

随着对糖尿病认识的不断深入,糖尿病的个体化治疗得到广泛认可。对于患者的饮食控制也从最早的统一的饥饿疗法,转变为目前的个体化能量平衡计划和医学营养治疗。过去几年中,循证医学和指南的更新更加清晰地指出,糖尿病的饥饿疗法并不是理想的医学营养治疗;正常热卡碳水化合物进食同样有利于控制血糖。血糖指数(glucose index,GI)是分析餐后高血糖原因认识上的一个突破,这也为胰岛素起始方案的确立提供了重要的参考依据。根据中国国情,中国2型糖尿病患者可能更适合预混胰岛素起始治疗方案。

With further understanding the pathogenesis of diabetes,individualized therapy for diabetes was gradually accepted.Each patient wassubjected to the transition from early uniform limotherapy to current individualized energy balance plan and medical nutrition therapy.For the pastdecades,evidence-based medicine and updated guidelines contributed to explain clearly:limotherapy is optimal and ideal medical nutrition therapy.Isocaloric carbohydrates could induce similar glucose targeting.Glucose index(GI)is addressed as breakthrough for reevaluating hyperglycemia,which provides evidences for insulin initiation.Premix insulin was an optimal choice of insulin initiation for Chinese type2diabetes mellitus.