一项回顾性研究比较了中性鱼精蛋白锌胰岛素与甘精胰岛素作为住院患者泼尼松相关性糖尿病的基础治疗。
A retrospective study comparing neutral protamine hagedorn insulin with glargine as basal therapy in prednisone-associated diabetes mellitus in hospitalized patients.
机构信息
Department of Medicine, Division of Endocrinology, Diabetes, and Metabolism, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.
出版信息
Endocr Pract. 2012 Sep-Oct;18(5):712-9. doi: 10.4158/EP11371.OR.
OBJECTIVE
To compare glycemic outcomes in hospitalized patients with or without type 2 diabetes mellitus receiving neutral protamine Hagedorn insulin (NPH) vs glargine as basal insulin for management of glucocorticoid-associated hyperglycemia.
METHODS
We conducted a retrospective review of electronic medical records in prednisone-treated adult patients with hyperglycemia in a university hospital. Consecutive patients were selected in both the NPH and glargine cohorts using inclusion and exclusion criteria. Baseline characteristics were assessed in each cohort. Glycemic outcomes were analyzed by comparing fasting blood glucose, mean daily blood glucose concentration, median daily blood glucose concentration, and the number of hypoglycemic episodes on a prespecified index day.
RESULTS
One hundred twenty patients were included: 60 patients in the NPH cohort and 60 patients in the glargine cohort. The weight-based insulin requirement was lower in the NPH cohort than in the glargine cohort (0.27 ± 0.2 units/kg vs 0.34 ± 0.2 units/kg [P = .04] for basal insulin and 0.26 ± 0.2 units/kg vs 0.36 ± 0.2 units/kg [P = .03] for bolus insulin). NPH and glargine cohorts were similar regarding age, sex, race, body mass index, hemoglobin A1c, serum creatinine, and prednisone dosage. Glycemic outcomes in the NPH cohort compared with outcomes in the glargine cohort were similar regarding mean fasting blood glucose concentration (134 ± 49 mg/dL vs 139 ± 54 mg/dL [P = .63]), mean daily blood glucose (167 ± 46 mg/dL vs 165 ± 52 mg/dL [P = .79]), median blood glucose (160 ± 49 mg/dL vs 159 ± 57 mg/dL [P = .90]), and number of hypoglycemic episodes per day (0.12 ± 0.3 vs 0.10 ± 0.3 [P = .77]).
CONCLUSIONS
NPH and glargine appear to be equally effective as basal insulin in the management of hyperglycemia in hospitalized patients receiving prednisone. However, the total daily insulin doses used were lower in the NPH cohort.
目的
比较中性鱼精蛋白锌胰岛素（NPH）与甘精胰岛素作为基础胰岛素治疗糖皮质激素相关性高血糖住院患者的血糖控制效果。
方法
我们对一家大学医院接受泼尼松治疗的高血糖成年患者的电子病历进行了回顾性分析。采用纳入和排除标准，在 NPH 组和甘精胰岛素组中连续选择患者。在每个队列中评估了基线特征。通过比较禁食血糖、平均每日血糖浓度、中位数每日血糖浓度以及指定索引日的低血糖发作次数来分析血糖控制效果。
结果
共纳入 120 例患者：NPH 组 60 例，甘精胰岛素组 60 例。NPH 组的基础胰岛素需要量低于甘精胰岛素组（0.27 ± 0.2 单位/千克比 0.34 ± 0.2 单位/千克[P =.04]，0.26 ± 0.2 单位/千克比 0.36 ± 0.2 单位/千克[P =.03]）。NPH 组和甘精胰岛素组在年龄、性别、种族、体重指数、糖化血红蛋白、血清肌酐和泼尼松剂量方面相似。与甘精胰岛素组相比，NPH 组的血糖控制效果在平均禁食血糖浓度（134 ± 49 mg/dL 比 139 ± 54 mg/dL[P =.63]）、平均每日血糖浓度（167 ± 46 mg/dL 比 165 ± 52 mg/dL[P =.79]）、中位数血糖浓度（160 ± 49 mg/dL 比 159 ± 57 mg/dL[P =.90]）和每日低血糖发作次数（0.12 ± 0.3 比 0.10 ± 0.3[P =.77]）方面相似。
结论
NPH 和甘精胰岛素在治疗接受泼尼松治疗的住院患者的高血糖方面似乎同样有效。然而，NPH 组的总日胰岛素剂量较低。
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