Bell D S, Ovalle F
Department of Medicine, Division of Endocrinology and Metabolism, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, USA.
Endocr Pract. 2000 Sep-Oct;6(5):357-60. doi: 10.4158/EP.6.5.357.
To compare, in a long-term study, glycemic control by means of continuous subcutaneous insulin infusion (CSII or insulin pump therapy) versus multiple insulin injection therapy (MIIT) in routine clinical practice.
We identified, from a search of medical records, all active patients (N = 90) receiving CSII who had previously received MIIT. The primary objective was to compare the mean glycemic control, as documented by frequent measurements of glycosylated hemoglobin (HbA(1c)), during the 3-year period before initiation of CSII versus the mean glycemic control during the 3-year period after the first year of CSII. We included all patients for whom we had sufficient data for at least 1 year for both the pre- and post-CSII periods and only those patients who had received MIIT before CSII (N = 58). To eliminate potential biases, we excluded HbA(1c) values for the first year after initiation of CSII therapy.
For the entire study group, the mean HbA(1c) +/- standard error for the 3-year period before insulin pump therapy (during MIIT) was 8.4 +/- 0.2% versus a mean HbA(1c) of 7.7 +/- 0.1% for the 3-year period after the first year of CSII. This 0.7% improvement in HbA(1c) was statistically significant (P = 0.001). Of the 34 patients with HbA(1c) values above 8.0% during MIIT, the mean HbA(1c) decreased from 9.2 +/- 0.2% with use of MIIT to 8.2 +/- 0.2% with CSII (P = 0.0006). In the 17 patients with HbA(1c) values above 9.0% during MIIT, the mean HbA(1c) declined from 10.0 +/- 0.3% with use of MIIT to 8.4 +/- 0.3% with CSII (P = 0.0006).
We conclude that implementation of intensive insulin therapy with CSII improves glycemic control, even in patients in whom MIIT has previously been used to its maximal effect.
在一项长期研究中，比较在常规临床实践中持续皮下胰岛素输注（CSII，即胰岛素泵治疗）与多次胰岛素注射治疗（MIIT）对血糖的控制情况。
通过查阅病历，我们找出了所有正在接受CSII治疗且之前接受过MIIT治疗的活跃患者（N = 90）。主要目的是比较开始CSII治疗前3年期间糖化血红蛋白（HbA1c）的频繁测量记录的平均血糖控制情况与CSII治疗第一年之后3年期间的平均血糖控制情况。我们纳入了在CSII治疗前后两个时期均有至少1年充分数据的所有患者，且仅纳入那些在CSII治疗前接受过MIIT治疗的患者（N = 58）。为消除潜在偏差，我们排除了CSII治疗开始后第一年的HbA1c值。
对于整个研究组，胰岛素泵治疗前3年期间（MIIT期间）的平均HbA1c±标准误为8.4±0.2%，而CSII治疗第一年之后3年期间的平均HbA1c为7.7±0.1%。HbA1c的这0.7%的改善具有统计学意义（P = 0.001）。在MIIT期间HbA1c值高于8.0%的34例患者中，平均HbA1c从MIIT治疗时的9.2±0.2%降至CSII治疗时的8.2±0.2%（P = 0.0006）。在MIIT期间HbA1c值高于9.0%的17例患者中，平均HbA1c从MIIT治疗时的10.0±0.3%降至CSII治疗时的8.4±0.3%（P = 0.0006）。
我们得出结论，即使在之前已将MIIT发挥到最大效果的患者中，实施CSII强化胰岛素治疗也能改善血糖控制。
