Anstey J, Yassaee A, Solomon A
UCL Medical School, University College London.
Royal Free London NHS Foundation Trust, London.
Diabet Med. 2015 Oct;32(10):1279-88. doi: 10.1111/dme.12740. Epub 2015 Mar 31.
To provide a systematic review of the current evidence concerning the diabetes-related outcomes of patients provided with continuous subcutaneous insulin infusion for treating diabetes mellitus while a hospital inpatient.
Relevant publications were obtained from MEDLINE and EMBASE databases concerning hospital inpatients with diabetes being treated with continuous subcutaneous insulin infusion. Studies were assessed independently by two reviewers, and data on the following outcomes were extracted: inpatient mortality; clinical complications, e.g. diabetic ketoacidosis; hyperglycaemia; hypoglycaemia; length of hospital stay; mean bedside glucose level; and glucose level on discharge. Obstetric cases were examined separately to look at maternal and neonatal glycaemic outcomes.
A total of 11 studies met the required criteria and were analysed in detail, 5 of which were predominantly obstetric. No significant complications were reported, with no incidences of death, ketoacidosis or severe hypoglycaemia. Length of hospital stay appeared to be shorter in those patients who remained on continuous subcutaneous insulin infusion, while data on mild hyperglycaemia and hypoglycaemia were inconclusive.
There are limited data available to form a significant conclusion about the safety of continuous subcutaneous insulin infusion continuation in hospital; however, its use can be justified with the presence of a specialized inpatient diabetes team for advice and support and an alternative treatment regime (e.g. subcutaneous basal bolus) should be accessible if the need were to arise.
对目前有关住院糖尿病患者接受持续皮下胰岛素输注治疗的糖尿病相关结局的证据进行系统综述。
从MEDLINE和EMBASE数据库中获取有关住院糖尿病患者接受持续皮下胰岛素输注治疗的相关出版物。由两名评审员独立评估研究，并提取以下结局的数据：住院死亡率；临床并发症，如糖尿病酮症酸中毒；高血糖；低血糖；住院时间；平均床边血糖水平；以及出院时的血糖水平。对产科病例单独进行检查，以观察母婴血糖结局。
共有11项研究符合要求标准并进行了详细分析，其中5项主要为产科研究。未报告显著并发症，无死亡、酮症酸中毒或严重低血糖事件。持续接受皮下胰岛素输注的患者住院时间似乎较短，而关于轻度高血糖和低血糖的数据尚无定论。
关于住院期间继续进行持续皮下胰岛素输注的安全性，可用于形成重要结论的数据有限；然而，如果有专业的住院糖尿病团队提供建议和支持，且在有需要时可采用替代治疗方案（如皮下基础追加量胰岛素注射），则其使用是合理的。
