Uhlobo loku-1 lweswekile

Uhlobo loku-1 lweswekileyimeko ebangelwa kukonakala okuzimelayo kwe-insulin-evelisa ii-b-cell ze-pancreatic islets, edla ngokukhokelela ekuswelekeni kwe-insulin engapheliyo.Uhlobo loku-1 lweswekile lubalelwa malunga ne-5-10% yazo zonke iimeko zeswekile.Nangona iziganeko ziphezulu ekufikiseni nasekukhuleni kwabantu abadala, uhlobo olutsha lwesifo seswekile lwe-1 lwenzeka kuwo onke amaqela eminyaka kwaye abantu abanesifo seswekile se-1 bahlala kumashumi eminyaka emva kokuqala kwesi sifo, njengokuba ukuxhaphaka ngokubanzi kohlobo lwe-1 yeswekile. phezulu kubantu abadala kunabantwana, sithethelela ukugxila kwethu kuhlobo lwe-1 yeswekile kubantu abadala (1).Ukuxhaphaka kwehlabathi lohlobo lwe-1 yeswekile yi-5.9 kubantu abayi-10,000, ngelixa iziganeko ziye zanda ngokukhawuleza kwiminyaka eyi-50 edlulileyo kwaye ngoku kuqikelelwa ukuba yi-15 kubantu abayi-100,000 ngonyaka (2).
Ngaphambi kokufunyanwa kwe-insulin kwinkulungwane eyadlulayo, uhlobo lwesifo seswekile soku-1 lwalunxulunyaniswa nobomi obulindelekileyo njengeenyanga ezimbalwa.Ukususela ngo-1922, i-insulin ekrwada ephuma kwi-pancreas yezilwanyana, yayisetyenziselwa ukunyanga abantu abanesifo seswekile soku-1.Kwiminyaka emashumi alandelayo, ukugxilwa kwe-insulin kwakusemgangathweni, izisombululo ze-insulin zaba nyulu ngakumbi, okubangele ukunciphisa i-immunogenicity, kunye ne-additives, ezifana ne-zinc kunye ne-protamine, zifakwe kwizisombululo ze-insulin ukwandisa ubude besenzo.Kwiminyaka yoo-1980, kwaphuhliswa i-semisynthetic kunye ne-recombinant insulins yabantu, kwaye phakathi koo-1990, i-insulin analogues yafumaneka.I-Basal insulin analogues zenzelwe ixesha elide lokusebenza kunye nokunciphisa ukuhluka kwe-pharmacodynamic xa kuthelekiswa ne-protaminebased (NPH) ye-insulin yabantu, ngelixa i-analogs esebenza ngokukhawuleza yaziswa ngokukhawuleza kunye nobude obufutshane kune-insulin esebenza ixesha elifutshane ("eqhelekileyo"), ekhokelela ekunciphiseni. kwangethuba emva kokutyai-hyperglycemiakwaye ngaphantsi kamvai-hypoglycemiaiiyure eziliqela emva kokutya (3).

Ukufunyanwa kwe-insulin kwaguqula ubomi babantu abaninzi, kodwa ngokukhawuleza kwabonakala ukuba uhlobo lwe-1 yeswekile lunxulunyaniswa nokuphuhliswa kweengxaki zexesha elide kunye nokunciphisa ixesha lokuphila.Kwiminyaka eyi-100 edlulileyo, uphuhliso lwe-insulin, ukuhanjiswa kwayo, kunye nobuchwepheshe bokulinganisa i-glycemic indices iye yatshintsha ngokuphawulekayo ulawulo lwe-1 yeswekile.Nangona le nkqubela phambili, abantu abaninzi abanesifo sikashukela sohlobo lwe-1 abafikeleli kwiithagethi ze-glycemic eziyimfuneko ukukhusela okanye ukucotha ukuqhubela phambili kweengxaki zesifo sikashukela, eziqhubekayo zenza umthwalo ophezulu wekliniki kunye neemvakalelo.
Ukuqaphela umngeni oqhubekayo wohlobo lwe-1 yeswekile kunye nophuhliso olukhawulezayo lonyango olutsha kunye nobuchwepheshe,Umbutho waseYurophu woFundo lwesifo seswekile (EASD)kwaye iUmbutho wesifo seswekile waseMelika (ADA)wabiza iqela lokubhala ukuphuhlisa ingxelo yokuvumelana malunga nokulawulwa kohlobo lwe-1 yeswekile kubantu abadala, abaneminyaka eyi-18 nangaphezulu.Iqela lokubhala laliqaphela zombini izikhokelo zelizwe kunye nezizwe ngezizwe malunga nohlobo lwe-1 yeswekile kwaye alizange lifune ukuphindaphinda oku, kodwa kunoko lijolise ekugxininiseni imimandla emikhulu yokunyamekela ukuba abaqeqeshi bezempilo kufuneka baqwalasele xa belawula abantu abadala abanesifo sikashukela sohlobo lwe-1.Ingxelo yokuvumelana igxininise kakhulu kwizicwangciso zangoku kunye nezexesha elizayo zokulawula i-glycemic kunye neemeko ezingxamisekileyo ze-metabolic.Inkqubela phambili yamva nje yokuxilongwa kwesifo seswekile se-1 iye yaqwalaselwa.Ngokungafaniyo nezinye iimeko ezininzi ezingapheliyo, uhlobo lwe-1 yeswekile lubeka umthwalo okhethekileyo wokulawula kumntu onemeko.Ukongeza kwiirejimeni zamayeza anzima, olunye uhlengahlengiso lokuziphatha luyafuneka;Konke oku kufuna ulwazi kunye nobuchule bokuhamba phakathi kwe-hyper- kunye ne-hypoglycemia.Ukubaluleka kweimfundo kunye nenkxaso yokulawula isifo seswekile (DSMES)kunye nokhathalelo lwengqondo lubhalwe ngokufanelekileyo kwingxelo.Ngelixa uvuma ukubaluleka okukhulu kunye neendleko zokuhlola, ukuxilonga, kunye nokulawula iingxaki ezingapheliyo ze-microvascular kunye ne-macrovascular yesifo sikashukela, inkcazo ecacileyo yokulawulwa kwezi ngxaki ingaphaya komxholo wale ngxelo.
Iimbekiselo
1. Miller RG, Secrest AM, Sharma RK, Songer TJ, Orchard TJ.Uphuculo kubomi obulindelekileyo bohlobo lwe-1 yeswekile: i-Pittsburgh Epidemiology ye-Diabetes Complications study cohort.Isifo seswekile
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2. U-Mobasseri M, uShirmohammadi M, u-Amiri T, uVahed N, uHosseini Fard H, uGhojazadeh M. Ukuxhaphaka kunye neziganeko ze-1 yesifo sikashukela kwihlabathi: ukuphononongwa ngokuchanekileyo kunye nohlalutyo lwe-meta.HealthPromotPerspect2020;10:98–115
3. Hirsch IB, Juneja R, Beals JM, Antalis CJ, Wright EE.Ukuvela kwe-insulin kunye nendlela eyazisa ngayo unyango kunye nokukhetha unyango.Endocr Rev2020;41:733–755