2 型糖尿病的短期强化胰岛素治疗：系统评价和荟萃分析。

Short-term intensive insulin therapy in type 2 diabetes mellitus: a systematic review and meta-analysis.

机构信息

Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada; Division of Endocrinology, University of Toronto, Toronto, ON, Canada.

Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, ON, Canada; Samuel Lunenfeld Research Institute, Mount Sinai Hospital, Toronto, ON, Canada; Division of Endocrinology, University of Toronto, Toronto, ON, Canada.

出版信息

Lancet Diabetes Endocrinol. 2013 Sep;1(1):28-34. doi: 10.1016/S2213-8587(13)70006-8. Epub 2013 Feb 4.

DOI:10.1016/S2213-8587(13)70006-8

PMID:24622264

Abstract

BACKGROUND

Studies have shown that, when implemented early in the course of type 2 diabetes mellitus, treatment with intensive insulin therapy for 2-3 weeks can induce a glycaemic remission, wherein patients are able to maintain normoglycaemia without any anti-diabetic medication. We thus did a systematic review and meta-analysis of interventional studies to assess the effect of short-term intensive insulin therapy on the pathophysiological defects underlying type 2 diabetes mellitus (pancreatic β-cell dysfunction and insulin resistance) and identify clinical predictors of remission.

METHODS

We identified studies published between 1950 and Nov 19, 2012, which assessed the effect of intensive insulin therapy on β-cell function or insulin resistance, or both, or assessed long-term drug-free glycaemic remission in adults aged 18 years or older with newly diagnosed type 2 diabetes mellitus. We calculated pooled estimates by random-effects model. This study is registered with International Prospective Register of Systematic Reviews, number CRD42012002829.

FINDINGS

We identified 1645 studies of which seven fulfilled inclusion criteria (n=839 participants). Five studies were non-randomised. A pooled analysis of the seven studies showed a post-intensive insulin therapy increase in Homeostasis Model Assessment of β-cell function as compared with baseline (1·13, 95% CI 1·02 to 1·25) and a decrease in Homeostasis Model Assessment of Insulin Resistance (-0·57, -0·84 to -0·29). In the four studies that assessed glycaemic remission (n=559 participants), the proportion of participants in drug-free remission was about 66·2% (292 of 441 patients) after 3 months of follow-up, about 58·9% (222 of 377 patients) after 6 months, about 46·3% (229 of 495 patients) after 12 months, and about 42·1% (53 of 126 patients) after 24 months. Patients who achieved remission had higher body-mass index than those who did not achieve remission (1·06 kg/m(2), 95% CI 0·55 to 1·58) and lower fasting plasma glucose (-0·59 mmol/L, 95% CI -1·11 to -0·07) at baseline.

INTERPRETATION

Short-term intensive insulin therapy can improve the underlying pathophysiology in early type 2 diabetes mellitus, and thus might provide a treatment strategy for modifying the natural history of diabetes.

FUNDING

None.

摘要

背景

研究表明，在 2 型糖尿病早期实施强化胰岛素治疗 2-3 周，可诱导血糖缓解，使患者在不使用任何抗糖尿病药物的情况下维持正常血糖。因此，我们对干预性研究进行了系统评价和荟萃分析，以评估短期强化胰岛素治疗对 2 型糖尿病（胰岛β细胞功能障碍和胰岛素抵抗）潜在病理生理缺陷的影响，并确定缓解的临床预测因素。

方法

我们检索了 1950 年至 2012 年 11 月 19 日期间发表的研究，评估强化胰岛素治疗对胰岛β细胞功能或胰岛素抵抗或两者的影响，或评估新诊断为 2 型糖尿病的成年患者无药物治疗的长期血糖缓解。我们通过随机效应模型计算了汇总估计值。本研究已在国际前瞻性系统评价注册处（International Prospective Register of Systematic Reviews）注册，编号为 CRD42012002829。

结果

我们共检索到 1645 项研究，其中 7 项符合纳入标准（n=839 名参与者）。其中 5 项研究为非随机研究。7 项研究的荟萃分析显示，强化胰岛素治疗后，稳态模型评估的胰岛β细胞功能较基线增加（1·13，95%CI 1·02 至 1·25），稳态模型评估的胰岛素抵抗降低（-0·57，-0·84 至-0·29）。在 4 项评估血糖缓解的研究中（n=559 名参与者），在 3 个月的随访后，无药物治疗缓解的参与者比例约为 66.2%（441 名患者中的 292 名），6 个月后约为 58.9%（377 名患者中的 222 名），12 个月后约为 46.3%（495 名患者中的 229 名），24 个月后约为 42.1%（126 名患者中的 53 名）。达到缓解的患者的体重指数高于未达到缓解的患者（1·06 kg/m2，95%CI 0·55 至 1·58），且空腹血糖较低（-0·59 mmol/L，95%CI -1·11 至 -0·07）。