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.
Lancet Diabetes Endocrinol. 2013 Sep;1(1):28-34. doi: 10.1016/S2213-8587(13)70006-8. Epub 2013 Feb 4.
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.
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.
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.
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.
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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。
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。
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）。
短期强化胰岛素治疗可改善 2 型糖尿病早期的潜在病理生理学改变，因此可能为改变糖尿病的自然病程提供一种治疗策略。
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