皮下注射速效胰岛素治疗糖尿病酮症酸中毒是否能减少重症监护病房的收治需求？
Does Management of Diabetic Ketoacidosis with Subcutaneous Rapid-acting Insulin Reduce the Need for Intensive Care Unit Admission?
作者信息
Cohn Brian G, Keim Samuel M, Watkins Joseph W, Camargo Carlos A
机构信息
Division of Emergency Medicine, Washington University School of Medicine, St. Louis, Missouri.
Department of Emergency Medicine, The University of Arizona College of Medicine, Tucson, Arizona.
出版信息
J Emerg Med. 2015 Oct;49(4):530-8. doi: 10.1016/j.jemermed.2015.05.016. Epub 2015 Jul 31.
BACKGROUND
In the last 20 years, rapid-acting insulin analogs have emerged on the market, including aspart and lispro, which may be efficacious in the management of diabetic ketoacidosis (DKA) when administered by non-intravenous (i.v.) routes.
CLINICAL QUESTION
In patients with mild-to-moderate DKA without another reason for intensive care unit (ICU) admission, is the administration of a subcutaneous (s.c.) rapid-acting insulin analog a safe and effective alternative to a continuous infusion of i.v. regular insulin, and would such a strategy eliminate the need for ICU admission?
EVIDENCE REVIEW
Five randomized controlled trials were identified and critically appraised.
RESULTS
The outcomes suggest that there is no difference in the duration of therapy required to resolve DKA with either strategy.
CONCLUSION
Current evidence supports DKA management with s.c. rapid-acting insulin analogs in a non-ICU setting in carefully selected patients.
背景
在过去20年里，速效胰岛素类似物已投放市场，包括门冬胰岛素和赖脯胰岛素，当通过非静脉途径给药时，它们可能对糖尿病酮症酸中毒（DKA）的治疗有效。
临床问题
在没有其他入住重症监护病房（ICU）原因的轻至中度DKA患者中，皮下注射速效胰岛素类似物是否是持续静脉输注正规胰岛素的安全有效替代方法，并且这样的策略是否可以消除入住ICU的必要性？
证据综述
检索并严格评价了5项随机对照试验。
结果
结果表明，两种策略在解决DKA所需的治疗持续时间上没有差异。
结论
目前的证据支持在精心挑选的患者中，在非ICU环境下使用皮下注射速效胰岛素类似物治疗DKA。
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