2型糖尿病患者多次皮下胰岛素注射强化治疗剂量调整方案的荟萃分析  

Dose titration regimen of intensive treatment with multiple subcutaneous insulin injections in patients with type 2 diabetes:a Meta⁃analysis

作　　者：吕芳 蔡晓凌[1] 纪立农[1] LYV Fang;CAI Xiaoling;JI Linong(Department of Endocrinology,Peking University People’s Hospital,Beijing 100044,China)

机构地区：[1]北京大学人民医院内分泌科,100044

出　　处：《中国糖尿病杂志》2021年第5期353-361,共9页Chinese Journal of Diabetes

基　　金：北京市自然科学基金(7202216);北京大学人民医院研究与发展基金资助课题(RDY2019‐22)。

摘　　要：目的通过荟萃分析总结T2DM患者多次皮下胰岛素注射强化治疗的剂量调整方案。方法检索美国国立医学图书馆数据库、循证医学数据库和荷兰医学文摘数据库,选择从建立之日起至2020年6月10日发表的以长效胰岛素和短效/速效胰岛素为基础‐餐时治疗方案的随机对照试验,采用Review Manager 5.3软件对剂量调整方案进行荟萃分析。结果共纳入7470例以长效胰岛素联合短效/速效胰岛素为强化治疗方案的T2DM患者,试验终点时长效胰岛素和短效/速效胰岛素的平均剂量为(0.63±0.42)U/(kg·d)和(0.54±0.56)U/(kg·d)。长效胰岛素主要根据早餐前FBG进行调整。餐时胰岛素在大多数研究中根据下一餐前血糖调整,部分研究也结合餐后血糖调整。结论在以餐时胰岛素联合长效胰岛素为强化治疗方案的T2DM患者中,每日胰岛素总剂量为1.17 U/kg,长效胰岛素和短效/速效胰岛素比值约为54%:46%。Objective To summarize the dose titration regimen of intensive treatment with multiple subcutaneous insulin injections in patients with type 2 diabetes mellitus(T2DM)by a meta‐analysis and review.Methods Databases of PubMed,the Cochrane library,EMBASE were searched for randomized controlled trials(RCTs)with therapies of basal bolus regimens,which assessed the efficacy of long‐acting insulin and short‐acting/rapid‐acting insulin from establishment of the database to June 10th,2020.Review Manager 5.3 was used for a meta‐analysis and review of the dose titration regimen.Results A total of 7470 patients with T2DM who had intensive therapy with long‐acting insulin and short‐acting/quick‐acting insulin were included.At the end of these studies,the average dose of long‐acting insulin and short‐acting/quick‐acting insulin were(0.63±0.42)U/(kg·d)and(0.54±0.56)U/(kg·d),respectively.The dose of long‐acting insulin was adjusted mainly according to fasting blood glucose before breakfast.The dose of preprandial insulin was adjusted according to the state of preprandial blood glucose before the next meal or in combination with postprandial blood glucose.Conclusion In patients with T2DM with insulin intensive treatment of basal bolus regimens,the total daily insulin dose was 1.17 U/kg,and the ratio of long‐acting insulin and short‐acting/fast‐acting insulin was about 54%:46%.

关 键 词：糖尿病 2型 长效胰岛素 短效/速效胰岛素 强化治疗 

分 类 号：R587.1[医药卫生—内分泌]