胰岛素治疗的系统风险

The system risk of insulin treatment

目的胰岛素是常用降血糖注射剂。本文旨在分析胰岛素治疗的风险,为临床治疗提供参考。方法临床研究包括2型糖尿病(T2DM)患者和危症患者。前瞻性研究观察华人T2DM 2906例(其中胰岛素治疗971例),连续随访7年。横断面资料研究中美国T2DM 25964例,英国T2DM 84622例。死亡、癌症、慢性并发症、低血糖与危症是主要临床终点。结果胰岛素治疗显著增加T2DM临床终点事件风险:死亡(HR=2.2;95%CI=2.0-2.4),癌症(HR=1.4;95%CI=1.2-1.7),肾病(HR=3.5;95%CI=2.7-4.5),心肌梗死(HR=2.0;95%CI=1.5-2.6),主要不良心脏事件(HR=1.7;95%CI=1.4-2.1),中风(HR=1.4;95%CI=1.2-1.8)。胰岛素治疗的危症患者6026例,出现低血糖,其死亡风险呈线性升高:中度低血糖组HR=1.4,95%CI=1.2-1.6;严重性低血糖组HR=2.1,95%CI=1.6-2.8。结论糖尿病患者及危症患者应慎用胰岛素治疗,胰岛素治疗的系统风险不容低估。

Objective Insulin is widely use for the control of blood glucose. Hereby we evaluated the hazards of insu-lin treatment to provide the reference for the clinical treatment. Methods Data were extracted from 5 clinical studies of sub-jects with type 2 diabetes（T2Dm）and patients with critical illness. Prospective controlled trial involved 2906 Chinese T2Dm persons（insulin users,971）followed up to 7 years. Two more T2Dm cohorts were from USA（ n = 25964）and UK（ n =84622）conducted by cross-sectional analysis. major clinical endpoints included all-cause mortality,all - site cancer,chronic complication,and severe hypoglycemia. Results Use of insulin injection substantially increased the hazard risk（HR）of all the major clinical endpoints：all cause mortality（HR = 2. 2;95% CI = 2. 0 - 2. 4）,cancer（HR = 1. 4;95% CI = 1. 2 - 1. 7）, renal complication（HR = 3. 5;95% CI = 2. 7 - 4. 5）,myocardial infarction（HR = 2. 0;95% CI = 1. 5 - 2. 6）,major adverse cardiac events（HR = 1. 7;95% CI = 1. 4 - 2. 1）,stroke（HR = 1. 4;95% CI = 1. 2 - 1. 8）. 6026 critically ill patients showed linear HR of death with insulin - induced moderate hypoglycemia（HR = 1. 4,95% CI = 1. 2 - 1. 6）or severe hypoglycemia （HR = 2. 1,95% CI = 1. 6 - 2. 8）. Conclusions Patients with diabetes or critical illness should be cautious about using insu-lin. The system hazard risk of using insulin is generally underestimated.