胰岛素注射指南有循证依据吗?各国胰岛素注射指南的系统评价

Are the insulin injection guidelines really evidence-based?A systematic review of different guideline recommendations regarding insulin injection

目的系统评价各国胰岛素注射指南关于针头是否重复使用、轮换注射部位的方法、不同胰岛素注射不同部位以及注射针头长度的循证依据。方法计算机检索PubMed、Medline、Embase、中国知网、维普数据库、万方数据库(1946年1月至2016年12月),搜索美国、澳大利亚、加拿大、丹麦、中国香港、荷兰、英国糖尿病教育学会官网(至2016年12月),按纳入和排除标准纳入胰岛素注射指南。两名研究人员根据指南研究和评价标准独立筛选并评价纳入指南的质量,提取相关数据进行评价。结果初检出相关文献967100篇,最终纳入10项指南,均发表于2007至2016年之间。系统评价发现,就各指南引用的证据而言,一针一用、在不同区域轮换注射(即大轮换,区别于同一部位轮换)以及不同胰岛素(如短效、中效等)应注射不同区域的建议所引用的依据缺乏准确性。结论现有胰岛素注射指南的部分建议证据引用不充分,将来需要开展更多与胰岛素注射相关的临床随机对照试验,为胰岛素注射指南的制定提供科学依据。

Objective The purpose of this systematic review was to evaluate evidence for different guideline recommendations regarding needle reuse,rotation,injection site for a certain type of insulin and needle length,and to assess whether these recommendations are evidence-based.Methods A search of computer was carried out in PubMed,Medline,Embase,CNKI,Weipu data,Wanfang data from 1946 to December 2016,and diabetes education official websites in United States,Australia,Canada,Denmark,Hongkong(China),Netherlands and United Kingdom for insulin injection guidelines published before December 2016.All inclusions of guidelines for insulin injection followed the criteria of inclusion and exclusion.Two researchers independently screened and evaluated the quality of included guidelines with Appraisal of Guidelines for Research and Evaluation,and then extracted relevant data for analysis.Results In the original search,967100 literatures were identified,and 10 guidelines were included in the final review.Guidelines were published from 2007 to 2016.We found that evidence of recommendations on using the pen needle only once,rotating the injection sites among different anatomic areas(abdomen,thigh,arm and buttocks)and determining the injection sites by insulin type are not accurate enough.Conclusion In these existing guidelines for insulin injection,some recommendations are not fully strict.Further randomised clinical trial is warranted to provide scientific basis for developing the recommendations.