Dungan Kathleen M, Osei Kwame, Gaillard Trudy, Moore Jared, Binkley Philip
Division of Endocrinology, Diabetes, and Metabolism, The Ohio State University, Columbus, OH, USA.
Diabetes Metab Res Rev. 2015 Jan;31(1):93-101. doi: 10.1002/dmrr.2569.
The study aims to determine whether the route of insulin administration influences glycaemic variability and inflammatory or neurohormonal markers in patients with type 2 diabetes and congestive heart failure (CHF) exacerbation.
Patients (n = 65) were randomized to intravenous (IV) insulin (duration 48 h) or subcutaneous (SQ) insulin. Inflammatory cytokines and markers of lipid oxidation, high-frequency heart rate variability (n = 27) and cardiac impedance (pre-ejection period, n = 28) were used to estimate parasympathetic and sympathetic tone in patients with valid cardiac data. Glycaemic variability was measured using a continuous glucose monitor.
Mean glucose was lower (7.7 ± 1.2 vs 9.4 ± 2.7 mmol/L, p = 0.004), coefficient of variation was higher (p = 0.03) and glycaemic lability index was similar on day 1 in the IV group compared with the SQ group, but groups were similar by day 2. The IV group had more confirmed hypoglycaemia (p = 0.005). There were no differences in hospital readmission or hospital length of stay between groups. There were no differences in CHF biomarkers, heart rate variability or pre-ejection period between groups. Increasing log glycaemic lability index was associated with lower on-treatment pre-ejection period (p = 0.03) while increasing coefficient of variation was associated with increasing brain natriuretic peptide (p = 0.004) and paroxonase-1 (p = 0.02). Other univariable analyses were not significant.
There were modest, transient differences in glucose control between IV and SQ insulin in hospitalized CHF patients. However, the analyses do not support a link between insulin route and inflammatory markers or autonomic tone. Further study is needed to assess outcomes in hospitalized CHF patients.
本研究旨在确定胰岛素给药途径是否会影响2型糖尿病合并充血性心力衰竭（CHF）加重患者的血糖变异性以及炎症或神经激素标志物。
将患者（n = 65）随机分为静脉注射（IV）胰岛素组（持续48小时）或皮下（SQ）胰岛素组。对于有有效心脏数据的患者，使用炎症细胞因子、脂质氧化标志物、高频心率变异性（n = 27）和心脏阻抗（射血前期，n = 28）来评估副交感神经和交感神经张力。使用连续血糖监测仪测量血糖变异性。
与皮下注射组相比，静脉注射组第1天的平均血糖较低（7.7±1.2 vs 9.4±2.7 mmol/L，p = 0.004），变异系数较高（p = 0.03），血糖不稳定指数相似，但第2天两组相似。静脉注射组有更多确诊的低血糖症（p = 0.005）。两组之间的再入院率或住院时间没有差异。两组之间的CHF生物标志物、心率变异性或射血前期没有差异。血糖不稳定指数对数增加与治疗时的射血前期降低相关（p = 0.03），而变异系数增加与脑钠肽增加（p = 0.004）和对氧磷酶-1增加（p = 0.02）相关。其他单变量分析无统计学意义。
住院CHF患者中，静脉注射胰岛素和皮下注射胰岛素在血糖控制方面存在适度的短暂差异。然而，分析结果不支持胰岛素给药途径与炎症标志物或自主神经张力之间存在联系。需要进一步研究以评估住院CHF患者的预后。
