AIM:To evaluate the impact on glucose variability(GLUCV)of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity.METHODS:We enrolled...AIM:To evaluate the impact on glucose variability(GLUCV)of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity.METHODS:We enrolled 44 type 2 diabetic patients(n=32 males;n=12 females)with acute coronary syndrome(ACS)and randomy assigned to standard a subcutaneous insulin treatment(n=23)or a nurse-implemented continuous intravenous insulin infusion protocol(n=21).We utilized some parameters of GLUCV representing well-known surrogate markers of prognosis,i.e.,glucose standard deviation(SD),the mean dailyδglucose(mean of daily difference between maximum and minimum glucose),and the coefficient of variation(CV)of glucose,expressed as percent glucose(SD)/glu-cose(mean).RESULTS:At the admission,first fasting blood glucose,pharmacological treatments(insulin and/or anti-diabetic drugs)prior to entering the study and basal glycated hemoglobin(HbA1c)were observed in the two groups treated with subcutaneous or intravenous insulin infusion,respectively.When compared with patients submitted to standard therapy,insulin-infused patients showed both increased first 24-h(median 6.9 mmol/L vs 5.7mmol/L P<0.045)and overall hospitalizationδglucose(median 10.9 mmol/L vs 9.3 mmol/L,P<0.028),with a tendency to a significant increase in first 24-h glycaemic CV(23.1%vs 19.6%,P<0.053).Severe hypoglycaemia was rare(14.3%),and it was observed only in 3 patients receiving insulin infusion therapy.HbA1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of treatment.CONCLUSION:Our pilot data suggest that no real benefit in terms of GLUCV is observed when routinely managing blood glucose by insulin infusion therapy in type 2 diabetic ACS hospitalized patients in respect to conventional insulin展开更多
研究目的:比较胰岛素强化治疗(IIT)和常规胰岛素治疗(CIT)对创伤性脑损伤(TBI)患者临床转归的影响。研究方法:从MEDLINE、EMBASE、Google Scholar、ISI Web of Science和Cochrane Library系统搜索TBI患者的IIT与CIT的随机对照试验(RCT)...研究目的:比较胰岛素强化治疗(IIT)和常规胰岛素治疗(CIT)对创伤性脑损伤(TBI)患者临床转归的影响。研究方法:从MEDLINE、EMBASE、Google Scholar、ISI Web of Science和Cochrane Library系统搜索TBI患者的IIT与CIT的随机对照试验(RCT),并进行对比分析,从中提取研究特征、重症监护(ICU)事件和长期预后结果,使用随机形式进行荟萃分析。研究结果:获得包括1070个患者在内的7个RCT,尽管经过IIT治疗的患者有着更好的神经系统预后(GOS>3,RR=0.87,95%CI=0.78~0.97,P=0.01,I^2=0%),但敏感性分析显示其中的一项研究似乎影响了这一治疗方案的总体评估(RR=0.90,95%CI=0.80~1.01,P=0.07,I^2=0%),IIT与低血糖风险的增加密切相关(RR=5.79,95%CI=3.27~10.26,P<0.01,I^2=38%);在早期或晚期死亡率方面,IIT和CIT似乎没有差异(RR=0.96,95%CI=0.79~1.17,P=0.7,I^2=0%);感染率(RR=0.82,95%CI=0.59~1.14,P=0.23,I^2=68%)或ICU内停留时间(SMD=-0.14,95%CI=-0.35~0.07,P=0.18,I^2=45%)。研究结论:IIT不能改善长期神经系统预后、死亡率和感染率,并且与低血糖风险增加有关,应该设计更为严谨的TBI亚组RCT实验,以产生更有力的结论。展开更多
基金Supported by Fondazione CNR/Regione Toscana G Monasterio
文摘AIM:To evaluate the impact on glucose variability(GLUCV)of an nurse-implemented insulin infusion protocol when compared with a conventional insulin treatment during the day-to-day clinical activity.METHODS:We enrolled 44 type 2 diabetic patients(n=32 males;n=12 females)with acute coronary syndrome(ACS)and randomy assigned to standard a subcutaneous insulin treatment(n=23)or a nurse-implemented continuous intravenous insulin infusion protocol(n=21).We utilized some parameters of GLUCV representing well-known surrogate markers of prognosis,i.e.,glucose standard deviation(SD),the mean dailyδglucose(mean of daily difference between maximum and minimum glucose),and the coefficient of variation(CV)of glucose,expressed as percent glucose(SD)/glu-cose(mean).RESULTS:At the admission,first fasting blood glucose,pharmacological treatments(insulin and/or anti-diabetic drugs)prior to entering the study and basal glycated hemoglobin(HbA1c)were observed in the two groups treated with subcutaneous or intravenous insulin infusion,respectively.When compared with patients submitted to standard therapy,insulin-infused patients showed both increased first 24-h(median 6.9 mmol/L vs 5.7mmol/L P<0.045)and overall hospitalizationδglucose(median 10.9 mmol/L vs 9.3 mmol/L,P<0.028),with a tendency to a significant increase in first 24-h glycaemic CV(23.1%vs 19.6%,P<0.053).Severe hypoglycaemia was rare(14.3%),and it was observed only in 3 patients receiving insulin infusion therapy.HbA1c values measured during hospitalization and 3 mo after discharge did not differ in the two groups of treatment.CONCLUSION:Our pilot data suggest that no real benefit in terms of GLUCV is observed when routinely managing blood glucose by insulin infusion therapy in type 2 diabetic ACS hospitalized patients in respect to conventional insulin
文摘研究目的:比较胰岛素强化治疗(IIT)和常规胰岛素治疗(CIT)对创伤性脑损伤(TBI)患者临床转归的影响。研究方法:从MEDLINE、EMBASE、Google Scholar、ISI Web of Science和Cochrane Library系统搜索TBI患者的IIT与CIT的随机对照试验(RCT),并进行对比分析,从中提取研究特征、重症监护(ICU)事件和长期预后结果,使用随机形式进行荟萃分析。研究结果:获得包括1070个患者在内的7个RCT,尽管经过IIT治疗的患者有着更好的神经系统预后(GOS>3,RR=0.87,95%CI=0.78~0.97,P=0.01,I^2=0%),但敏感性分析显示其中的一项研究似乎影响了这一治疗方案的总体评估(RR=0.90,95%CI=0.80~1.01,P=0.07,I^2=0%),IIT与低血糖风险的增加密切相关(RR=5.79,95%CI=3.27~10.26,P<0.01,I^2=38%);在早期或晚期死亡率方面,IIT和CIT似乎没有差异(RR=0.96,95%CI=0.79~1.17,P=0.7,I^2=0%);感染率(RR=0.82,95%CI=0.59~1.14,P=0.23,I^2=68%)或ICU内停留时间(SMD=-0.14,95%CI=-0.35~0.07,P=0.18,I^2=45%)。研究结论:IIT不能改善长期神经系统预后、死亡率和感染率,并且与低血糖风险增加有关,应该设计更为严谨的TBI亚组RCT实验,以产生更有力的结论。
