Galindo Rodolfo J, Davis Georgia M, Fayfman Maya, Reyes-Umpierrez David, Alfa David, Peng Limin, Tamler Ronald, Pasquel Francisco J, Umpierrez Guillermo E
Endocr Pract. 2017 Sep;23(9):1059-1066. doi: 10.4158/EP171804.OR. Epub 2017 Jul 6.
Glargine and detemir insulin are the two most commonly prescribed basal insulin analogues for the ambulatory and inpatient management of diabetes. The efficacy and safety of basal insulin analogues in the hospital setting has not been established.
This observational study compared differences in glycemic control and outcomes in non-intensive care unit patients with blood glucose (BG) >140 mg/dL who were treated with glargine or detemir, between January 1, 2012, and September 30, 2015, in two academic centers.
Among 6,245 medical and surgical patients with hyperglycemia, 5,749 received one or more doses of glargine, and 496 patients received detemir during the hospital stay. There were no differences in the mean daily BG (glargine, 182 ± 46 mg/dL vs. detemir, 180 ± 44 mg/dL; P = .70). There were no differences in mortality, hospital complications, or re-admissions between groups (all, P>.05). After adjusting for potential confounders, there was no statistically significant difference in hypoglycemia rates between treatment groups. Patients treated with detemir required higher total daily basal insulin doses (0.27 ± 0.16 units/kg/day vs. 0.22 ± 0.15 units/kg/day; P<.001). Glargine-treated patients had statistically longer length of stay; however, this difference may not be clinically relevant (6.8 ± 7.4 days vs. 6.0 ± 6.3 days; P<.001).
Our study indicates that treatment with glargine and detemir results in similar inpatient glycemic control in general medicine and surgery patients. Detemir treatment was associated with higher daily basal insulin dose and number of injections. A prospective randomized study is needed to confirm these findings.
BG = blood glucose BMI = body mass index CI = confidence interval eGFR = estimated glomerular filtration rate HbA1c = glycated hemoglobin ICD-9 = International Classification of Diseases, ninth revision ICU = intensive care unit IQR = interquartile range LOS = length-of-stay OR = odd ratio.
甘精胰岛素和地特胰岛素是门诊及住院糖尿病患者最常用的两种基础胰岛素类似物。基础胰岛素类似物在医院环境中的疗效和安全性尚未确立。
这项观察性研究比较了2012年1月1日至2015年9月30日期间，在两个学术中心，接受甘精胰岛素或地特胰岛素治疗的非重症监护病房血糖（BG）>140mg/dL患者的血糖控制差异和结局。
在6245例高血糖内科和外科患者中，5749例在住院期间接受了一剂或多剂甘精胰岛素，496例患者接受了地特胰岛素。平均每日血糖无差异（甘精胰岛素，182±46mg/dL vs地特胰岛素，180±44mg/dL；P = 0.70）。两组之间的死亡率、医院并发症或再入院率无差异（均P>0.05）。在调整潜在混杂因素后，治疗组之间的低血糖发生率无统计学显著差异。接受地特胰岛素治疗的患者每日基础胰岛素总剂量更高（0.27±0.16单位/千克/天vs 0.22±0.15单位/千克/天；P<0.001）。甘精胰岛素治疗的患者住院时间在统计学上更长；然而，这种差异可能不具有临床相关性（6.8±7.4天vs 6.0±6.3天；P<0.001）。
我们的研究表明，甘精胰岛素和地特胰岛素治疗在内科和外科患者中导致相似的住院血糖控制。地特胰岛素治疗与更高的每日基础胰岛素剂量和注射次数相关。需要进行前瞻性随机研究来证实这些发现。
BG =血糖；BMI =体重指数；CI =置信区间；eGFR =估计肾小球滤过率；HbA1c =糖化血红蛋白；ICD-9 =国际疾病分类第九版；ICU =重症监护病房；IQR =四分位数间距；LOS =住院时间；OR =比值比
