Rochester General Hospital, NY, USA.
Ann Pharmacother. 2013 Jan;47(1):20-8. doi: 10.1345/aph.1Q698. Epub 2013 Jan 16.
Most studies report using percentage of total daily insulin (TDI) for converting therapy from continuous insulin infusion to subcutaneous insulin in cardiac surgery patients. Few studies have evaluated the efficacy of using body weight to calculate the basal insulin dose.
To compare the efficacy and safety of dosing insulin glargine by weight versus percentage of TDI in cardiac surgery patients transitioning from continuous insulin infusion to subcutaneous insulin.
We conducted a prospective, randomized, open-label, pilot study. Study patients who had a preoperative weight less than 100 kg and were receiving at least 6 hours of a continuous insulin infusion were randomized to receive either 50% of their TDI requirement or 0.5 units/kg of glargine as a one-time dose 2 hours before stopping the continuous insulin infusion. All patients were administered subcutaneous corrective insulin. Blood glucose monitoring occurred before each meal, at bedtime, and with morning laboratory tests for 24 hours after administration of the glargine dose.
A total of 200 blood glucose measurements were performed in each group. The percentage of blood glucose measurements in target range (80-140 mg/dL) was similar between the weight-based group and the percentage-based group (66% vs 64%, p = 0.75). Median blood glucose after transition was 120 mg/dL (interquartile range [IQR] 99-147) in the weight-based group compared to 127 mg/dL (IQR 107-149; p = 0.03) in the percentage-based group. The median glargine dose was higher in the weight-based group (41 units; IQR 36-44) than in the weight-based group (24 units; IQR 14-30, p < 0.001). The rate of hypoglycemia (blood glucose <60 mg/dL) was 2.5% in each group.
In this small cohort, dosing insulin glargine by weight proved to be safe, but larger scale studies are needed before adopting weight-based dosing in this patient population.
大多数研究报告使用总胰岛素日剂量（TDI）的百分比将心脏手术患者的连续胰岛素输注转换为皮下胰岛素。很少有研究评估使用体重计算基础胰岛素剂量的效果。
比较在从连续胰岛素输注转换为皮下胰岛素的心脏手术患者中，按体重与 TDI 百分比给药甘精胰岛素的疗效和安全性。
我们进行了一项前瞻性、随机、开放标签、初步研究。术前体重小于 100kg 且接受至少 6 小时连续胰岛素输注的研究患者被随机分配接受 TDI 需求的 50%或甘精胰岛素 0.5 单位/公斤作为单次剂量，在停止连续胰岛素输注前 2 小时给予。所有患者均给予皮下校正胰岛素。在每次餐前、睡前以及给予甘精胰岛素剂量后 24 小时进行血糖监测，进行早晨实验室检查。
每组均进行了 200 次血糖测量。基于体重的组和基于百分比的组的目标范围内（80-140mg/dL）血糖测量百分比相似（66%与 64%，p=0.75）。基于体重的组在转换后中位数血糖为 120mg/dL（四分位距[IQR]99-147），而基于百分比的组中位数血糖为 127mg/dL（IQR 107-149；p=0.03）。基于体重的组甘精胰岛素剂量中位数较高（41 单位；IQR 36-44），而基于百分比的组甘精胰岛素剂量中位数较低（24 单位；IQR 14-30，p<0.001）。两组低血糖（血糖<60mg/dL）发生率均为 2.5%。
在这个小队列中，按体重给予甘精胰岛素证明是安全的，但在该患者人群中采用基于体重的剂量还需要更大规模的研究。
