胰岛素泵与多次胰岛素皮下注射治疗首诊2型糖尿病的系统评价

Contimuous subcutaneous insulin infusion versus multiple daily insulin injections in patients with newly diagnosed type 2 diabetes mellitus:a systematic review of randomized controlled trials

目的系统评价胰岛素泵和多次胰岛素皮下注射治疗首诊2型糖尿病患者的有效性和安全性。方法应用国际Cochrane协作网系统评价方法对胰岛素泵和多次胰岛素皮下注射比较治疗首诊2型糖尿病的随机对照试验进行评价。结果共纳入27个随机对照试验,包括1977例首诊的2型糖尿病患者。除1个试验方法学质量为高级,其他纳入试验均为中级。Meta分析结果显示:平均空腹血糖水平:胰岛素泵治疗优于多次胰岛素皮下注射治疗(P=0.03);平均餐后2小时血糖水平:胰岛素泵治疗不优于多次胰岛素皮下注射治疗(P=0.06);血糖达标时间、胰岛素用量和低血糖发生率:胰岛素泵治疗均优于多次胰岛素皮下注射治疗(P<0.001);糖尿病缓解率:胰岛素泵治疗不优于多次胰岛素皮下注射治疗(P=0.05)。结论基于目前的证据,对于首诊的2型糖尿病患者,早期使用胰岛素泵强化治疗,在血糖控制、血糖达标时间、胰岛素用量及低血糖发生上均优于多次胰岛素皮下注射治疗。

Objective To determine the effectiveness and safety of Contimuous subcutaneous insulin infusion and multiple daily insulin injections inpatients with newly diagnosed type 2 diabetes mellitus.Methods The systematic review was conducted with the method recommended by the Cochrane Collaboration.Results 27 trials involving 1977 patients were included.Results The average fasting glucose levels of Contimuous subcutaneous insulin infusion group was superior to that of multiple daily insulin injections group（P=0.03）.The average 2-h postbreakfast glucose levels of contimuous subcutaneous insulin infusion group was not superior to that of multiple daily insulin injections group（P=0.06）.The therapeutic time,insulin doses,hypoglycaemia of contimuous subcutaneous insulin infusion group was superior to that of multiple daily insulin injections group（P〈0.00001,P〈0.00001,P〈0.00001）.The rate of diabetes remission of contimuous subcutaneous insulin infusion group was not superior to that of multiple daily insulin injections group（P=0.05）.Conclusion The limited current evidence shows that contimuous subcutaneous insulin infusion was superior to multiple daily insulin injections in the management of newly-diagnosed type 2 diabetes.