诺和诺德医学资讯 / 学术前沿 / 2022年度荟萃
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究终点时HbA1c更优，提示使用CGM有助于降低基础胰岛素的治疗惰性。此外，与既往专家共识中提出的
TIR＞70%，TBR＜4%的控制目标有所不同，IDC提出在TIR＜70%或TBR＞2%时即提示需要调整基础胰岛
素治疗方案以减少高血糖及低血糖的发生。Martens教授总结出了根据CGM结果优化基础胰岛素治疗方案
需要分三步进行：第一，患者是否合并心血管及肾脏并发症，如有则优先联用GLP-1 RA以及SGLT2i类药物；
第二，解读AGP报告中的TIR以及TBR结果；第三，根据下表调整基础胰岛素剂量或联用药物（表1）。
智能胰岛素笔与CGM联合应用可有效减少遗漏注射的发生
在关于智能胰岛素笔的专题报告中，Viral N Shah教授指出目前胰岛素遗漏注射的现象在临床中较为常见，
而这种患者认为的“偶然事件”其实对总体血糖控制具有非常不利的影响。目前最新的智能胰岛素笔，可以
实现与电子移动设备上的多种APP互联，并且可以与CGM共同使用，通过整合患者血糖、饮食以及运动等数
据，为患者提供更好的胰岛素治疗方案管理支持。研究显示，T1DM患者通过使用智能胰岛素笔后，可显著
提高TIR，并减少遗漏注射的发生。
TIR/TBR Category Action Medication Adjustment Considerations Follow-up
表1 根据TIR及TBR结果调整基础胰岛素治疗方案的指导
话题来源：Session-New Strategies for Insulin use in Type 2 Diabetes；Topic-Overcoming Inertia——Using Continuous
Glucose Monitoring to Facilitate Effective Insulin Titration in People with Type 2 Diabetes on Basal-Insulin or
Basal-Bolus Insulin Regimens
话题来源：session-New Strategies for Insulin use in Type 2 Diabetes；Topic-Connected Insulin Pen in Managing Diabetes
Time in range >70%
and
Time below range s2%
Time in range >70%
and
Time below range >2%
Time in range s70%
and
Time below range s2%
Time in range s70%
and
Time below range >2%
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Continue
regimen
Address
hypoglycemia
Address
hyperglycemia
Address
hypoglycemia
today;
consider
referral to
diabetes
educator
3-4
months
● Continue to optimize current therapy; reinforce lifestyle changes and
taking insulin as prescribed
● Stop sulfonylurea if present and reduce background insulin by 10% if
TBR is8-12% or 15% if TBR is >12%
● lf not on sulfonylurea, decrease total background insulin dose by 10% if
TBR>2-7%; 15% if TBR 8-12%; 20% if TBR >12%
● Consider adding or adjusting GLP-1 RA, otherwise increase background
insulin dose bv 10% it TiR 51-70%; 15% if TIR 30-50%; 20% if TIR <30%
● lf overnight hypoglycemia, consider smaller increase in insulin dose
● Stopsulfonylurea if present and reduce background insulin dose by 10%
if TBR is 8-12% or 15% if TBR is >12%
● lfnotonsulfonvurea. decrease background insulin dose by 10% if TBR
>27%; 15% if TBR 8-12%; 20% if TBR >12%
● Referto diabetes educator for options to treat hyperglycemia including:
● Add or adjust GLP-1 RA (preferred) or add mealtime insulin before
one or all meals; consider premixed insulin twice per day if cost or
concern over insulin regimen complexity
2 weeks
2 weeks
2 weeks
