Kedia Rohit, Desouza Cyrus, Smith Lynette M, Shivaswamy Vijay
Department of Internal Medicine, Omaha, NE, United States.
VA Nebraska-Western Iowa Health Care System, Omaha, NE, United States; Department of Internal Medicine, Omaha, NE, United States.
J Diabetes Complications. 2017 May;31(5):874-879. doi: 10.1016/j.jdiacomp.2017.02.008. Epub 2017 Feb 21.
The aim of this study was to compare the changes in the total daily dose (TDD) of insulin of patients on U-500 insulin; before hospitalization, during hospitalization and six weeks after discharge.
A retrospective chart review of veterans with type 2 diabetes receiving U-500 insulin in the ambulatory setting and who were admitted between 2012 and 2015 was performed. During hospitalization, patients were transitioned to receive U-100 insulin (detemir or glargine for basal and aspart for bolus). Paired t-tests were conducted to compare TDD of insulin during hospitalization to prior to admission and at six week of follow-up.
The average hemoglobin A1 at the time of hospital admission was 8.3±1.5% (n=20). The average TDD of insulin during hospitalization (124±67units) was significantly less than prior to admission (295±123units) and at six week follow-up (310±105units). The average glucose during hospitalization was 180±36mg/dL. Hypoglycemia was less than 0.5%.
We showed that patients received significantly less total daily insulin while hospitalized compared to their insulin doses in the ambulatory setting, and we demonstrate that patients receiving U-500 insulin can be safely transitioned to U-100 insulin while hospitalized, with minimal hypoglycemia.
本研究旨在比较使用U-500胰岛素的患者在住院前、住院期间及出院后六周的每日胰岛素总剂量（TDD）变化。
对2012年至2015年间在门诊接受U-500胰岛素治疗并入院的2型糖尿病退伍军人进行回顾性病历审查。住院期间，患者转而接受U-100胰岛素（德谷胰岛素或甘精胰岛素用于基础胰岛素，门冬胰岛素用于餐时胰岛素）。采用配对t检验比较住院期间与入院前及随访六周时的胰岛素TDD。
入院时平均糖化血红蛋白为8.3±1.5%（n=20）。住院期间胰岛素平均TDD（124±67单位）显著低于入院前（295±123单位）及随访六周时（310±105单位）。住院期间平均血糖为180±36mg/dL。低血糖发生率低于0.5%。
我们发现，与门诊胰岛素剂量相比，患者住院期间每日胰岛素总剂量显著减少，并且我们证明，使用U-500胰岛素的患者在住院期间可安全转换为U-100胰岛素，低血糖发生率极低。
