The role of insulin analogues in the management of diabetes

摘要

Diabetes is a potentially devastating disease with a high morbidity and mortality. It is an excess risk of both microvascular and macrovascular complications which accounts, by and large, for this excess morbidity. Recent studies have illustrated how it might be possible to limit these diabetic complications. The Diabetes Control and Complications Trial (DCCT)1 and the UK Prospective Diabetes Study (UKPDS)2 found that improved control of blood glucose (and, in the latter trial, blood pressure) reduced the risk of major diabetic eye disease by one-quarter, serious deterioration of vision by nearly one-half, early kidney damage by one-third, strokes by one-third and death from diabetes-related causes by one-third. Other studies have demonstrated the importance of blood pressure control and reduced cholesterol as well as the use of aspirin in limiting progression of macrovascular disease. Diabetes is therefore no longer viewed as a disease of sugar alone; a more holistic approach is required if our patients are to benefit from the information we have acquired through these recent studies.