Division of Endocrinology, University of Colorado School of Medicine, Denver, Colorado 80045, USA.
J Clin Endocrinol Metab. 2012 Sep;97(9):3132-7. doi: 10.1210/jc.2012-1244. Epub 2012 Jun 8.
Transition of diabetic patients from iv insulin infusion to s.c. insulin frequently results in rebound hyperglycemia.
We hypothesized that initiation of a long-acting insulin therapy concurrently with i.v. insulin infusion would decrease the rate of rebound hyperglycemia after discontinuation of the insulin infusion.
Sixty-one diabetic patients receiving i.v. insulin therapy participated in this prospective randomized study. Subjects in the intervention group received daily injections of glargine s.c. (0.25 U/kg body weight) starting within 12 h of initiation of i.v. insulin infusion. Capillary blood glucose measurements were obtained up to 12 h after discontinuation of insulin infusion. Rebound hyperglycemia was defined as a blood glucose level greater than 180 mg/dl.
The study was conducted at the University of Colorado Hospital.
Sixty-one hospitalized patients with known type 1 or type 2 diabetes receiving i.v. insulin infusion participated in the study.
The primary outcome of this study was to compare the rates of rebound hyperglycemia between the control and the intervention groups after i.v. insulin infusion is discontinued.
Overall, 29 subjects in the control group (93.5%) had at least one glucose value above 180 mg/dl during the 12-h follow-up period. This was significantly greater than the rate of rebound hyperglycemia in the intervention group (10 subjects or 33.3%, P < 0.001). The effect of the intervention was apparent in subjects who presented with diabetic ketoacidosis, after solid organ transplantation, and in patients with other surgical and medical diagnoses. There were three hypoglycemic measurements in two control subjects (68, 62, and 58 mg/dl) and none in the intervention group.
Once-daily s.c. insulin glargine administered during i.v. insulin infusion is a safe method for preventing future rebound hyperglycemia, without increased risk of hypoglycemia.
糖尿病患者从静脉胰岛素输注转为皮下胰岛素注射时，经常会出现血糖反跳性升高。
我们假设在静脉输注胰岛素的同时开始长效胰岛素治疗，会降低停止输注胰岛素后血糖反跳的发生率。
61 名接受静脉胰岛素治疗的糖尿病患者参与了这项前瞻性随机研究。干预组的患者在开始静脉输注胰岛素后 12 小时内开始每天皮下注射甘精胰岛素（0.25U/kg 体重）。在停止胰岛素输注后 12 小时内测量毛细血管血糖。血糖反弹定义为血糖水平大于 180mg/dl。
该研究在科罗拉多大学医院进行。
61 名患有已知 1 型或 2 型糖尿病的住院患者接受静脉胰岛素输注治疗，参与了这项研究。
本研究的主要结果是比较静脉胰岛素输注停止后对照组和干预组血糖反弹的发生率。
总体而言，对照组 29 名患者（93.5%）在 12 小时的随访期间至少有一次血糖值高于 180mg/dl。这明显高于干预组的血糖反弹率（10 名患者或 33.3%，P<0.001）。该干预措施在患有糖尿病酮症酸中毒、实体器官移植后以及患有其他手术和医学诊断的患者中效果明显。对照组有 2 名患者（68、62 和 58mg/dl）出现 3 次低血糖测量，而干预组无低血糖测量。
在静脉输注胰岛素期间每天一次皮下注射甘精胰岛素是一种预防未来血糖反弹的安全方法，且不会增加低血糖的风险。
