Department of Endocrinology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, China.
Chin Med J (Engl). 2013 Nov;126(21):4030-6.
The probability and risk of operations increase in patients with type 2 diabetes mellitus. For diabetic patients, blood glucose control is a key factor to improving the prognosis of surgery. During perioperative period, insulin therapy is usually advised to be used for surgical patients with type 2 diabetes. However, the insulin regimen which one is better remains controversial. In this study, we estimated the efficacy, safety and advantage of different insulin therapy strategy during perioperative period.
A total of 1086 cases of surgical patients with type 2 diabetes mellitus enrolled in the present study. According to the glucose level at admission, all patients were divided into relatively high glucose group (group A, fasting blood glucose (FBG) ≤13.9 mmol/L) and higher glucose group (group B, FBG >13.9 mmol/L). Patients in group A randomly accepted premixed insulin twice a day, or basal insulin plus oral medications, and were divided into group A1 and A2 respectively. Patients in group B randomly received premixed insulin twice daily, basal insulin plus oral hypoglycemic agents, or basal insulin plus preprandial insulin, and were divided into group B1, B2 and B3 respectively. The data of the preoperative preparation time, the daily doses of insulin used in different periods, postoperative incision healed installments, hypoglycemic events, the total hospitalization time, postoperative complications were all collected and statistically analyzed.
Compared the main outcome measures in groups treated by premixed insulin therapy, both in preoperative preparation and postoperative period, the daily insulin dosage and the frequency of hypoglycemic events were decreased in groups treated by basal insulin therapy (P < 0.05). The preoperative preparation time and the total hospitalization time in groups with basal insulin therapy were shorter than that in groups with premixed insulin therapy (P < 0.05). The incision healing rate of stage I, II and III among different therapy protocols were significantly different (P < 0.05).
Basal insulin therapy could be used in diabetic patients undergoing elective major and medium surgery during whole perioperative period. Basal insulin therapy strategy, including a single injection of basal insulin and basal insulin plus preprandial insulin injection subcutaneously, is superior to premixed insulin therapy in the perioperative blood glucose management, and it could be viewed as the best choice in glucose control during perioperative period.
2 型糖尿病患者手术的概率和风险增加。对于糖尿病患者，血糖控制是改善手术预后的关键因素。在围手术期，通常建议 2 型糖尿病手术患者使用胰岛素治疗。然而，哪种胰岛素方案更好仍存在争议。在本研究中，我们评估了围手术期不同胰岛素治疗策略的疗效、安全性和优势。
本研究共纳入 1086 例 2 型糖尿病手术患者。根据入院时的血糖水平，所有患者分为相对高血糖组（A 组，空腹血糖（FBG）≤13.9mmol/L）和高血糖组（B 组，FBG＞13.9mmol/L）。A 组患者随机接受预混胰岛素 2 次/天，或基础胰岛素加口服药物治疗，并分为 A1 组和 A2 组。B 组患者随机接受预混胰岛素 2 次/天、基础胰岛素加口服降糖药，或基础胰岛素加餐前胰岛素治疗，并分为 B1、B2 和 B3 组。收集并统计分析术前准备时间、不同时期胰岛素日剂量、术后切口愈合分期、低血糖事件、总住院时间、术后并发症等数据。
与预混胰岛素治疗组的主要结局指标相比，基础胰岛素治疗组在术前准备和术后期间，胰岛素日剂量和低血糖事件的频率均降低（P＜0.05）。基础胰岛素治疗组的术前准备时间和总住院时间短于预混胰岛素治疗组（P＜0.05）。不同治疗方案的 I、II、III 期切口愈合率差异有统计学意义（P＜0.05）。
基础胰岛素可用于围手术期接受择期大、中型手术的糖尿病患者。基础胰岛素治疗策略，包括单次基础胰岛素注射和基础胰岛素加餐前胰岛素皮下注射，在围手术期血糖管理方面优于预混胰岛素治疗，可作为围手术期血糖控制的最佳选择。
