Insulin therapy: optimizing control in type 1 and type 2 diabetes.
Insulin has been available for therapeutic use for more than 75 years and remains a powerful pharmacologic tool with nearly unlimited potential to lower plasma glucose levels in patients with diabetes. Required essentially by all patients with type 1 diabetes and many patients with type 2 diabetes, insulin is capable of restoring near-normoglycemia--the primary treatment goal to forestall the onset and progression of long-term complications. Attainment and maintenance of near-normal glycemic control can be achieved with the use of insulin replacement strategies designed to simulate the physiologic, nondiabetic patterns of insulin secretion in response to 24-hour postabsorptive and postprandial glucose profiles. This article reviews the physiologic basis and current therapeutic agents for optimal insulin replacement and provides practical clinical guidelines and strategies to achieve near-normal glycemic control in patients with either type 1 or type 2 diabetes.
Rosenstock
J
J
University of Texas Southwestern Medical Center at Dallas, Dallas Diabetes and Endocrine Center, Dallas, Texas, USA.
D001786:Blood Glucose / Q000378:metabolism*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D007332:Insulin Infusion Systems; D016896:Treatment Outcome
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin