Department of Anaesthesiology, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Postbus 22660, 1105 AZ, Amsterdam, the Netherlands.
Intensive Care Unit, Royal Melbourne Hospital, 300 Grattan Street, Parkville, VIC, 3050, Australia.
Crit Care. 2018 Nov 14;22(1):299. doi: 10.1186/s13054-018-2197-4.
Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) are incretin hormones. By lowering blood glucose in a glucose-dependent manner, incretin-based therapies represent a novel and promising intervention to treat hyperglycaemia in hospital settings. We performed a systematic review of the literature for all current applications of incretin-based therapies in the peri-operative and critical care settings.
We searched MEDLINE, the Cochrane Library, and Embase databases for all randomised controlled trials using exogenous GLP-1, GLP-1 receptor agonists, exogenous GIP and dipeptidyl peptidase IV inhibitors in the setting of adult peri-operative care or intensive care. We defined no comparator treatment. Outcomes of interest included blood glucose, frequency of hypoglycaemia and insulin administration.
Of the 1190 articles identified during the initial literature search, 38 fulfilled criteria for full-text review, and 19 single-centre studies were subsequently included in the qualitative review. Of the 18 studies reporting glycaemic control, improvement was reported in 15, defined as lower glucose concentrations in 12 and as reduced insulin administration (with similar glucose concentrations) in 3. Owing to heterogeneity, meta-analysis was possible only for the outcome of hypoglycaemia. This revealed an incidence of 7.4% in those receiving incretin-based therapies and 6.8% in comparator groups (P = 0.94).
In small, single-centre studies, incretin-based therapies lowered blood glucose and reduced insulin administration without increasing the incidence of hypoglycaemia.
PROSPERO, CRD42017071926.
胰高血糖素样肽 1（GLP-1）和葡萄糖依赖性胰岛素促泌肽（GIP）是肠促胰岛素激素。通过葡萄糖依赖性降低血糖，基于肠促胰岛素的治疗代表了一种新颖且有前途的干预措施，可用于治疗医院环境中的高血糖症。我们对肠促胰岛素治疗在围手术期和重症监护环境中的所有当前应用进行了系统的文献回顾。
我们在 MEDLINE、Cochrane 图书馆和 Embase 数据库中搜索了所有使用外源性 GLP-1、GLP-1 受体激动剂、外源性 GIP 和二肽基肽酶 IV 抑制剂的随机对照试验，这些试验都设置在成人围手术期护理或重症监护中。我们将无对照治疗定义为没有对照治疗。感兴趣的结果包括血糖、低血糖发作的频率和胰岛素的使用。
在最初的文献搜索中，共确定了 1190 篇文章，其中 38 篇文章符合全文审查标准，随后有 19 项单中心研究纳入了定性综述。在报告血糖控制的 18 项研究中，有 15 项研究报告了改善，定义为 12 项研究中的血糖浓度降低，3 项研究中的胰岛素用量减少（血糖浓度相似）。由于存在异质性，仅对低血糖的结果进行了荟萃分析。结果显示，接受肠促胰岛素治疗的患者低血糖发生率为 7.4%，对照组为 6.8%（P=0.94）。
在小型单中心研究中，肠促胰岛素治疗可降低血糖并减少胰岛素的使用，而不会增加低血糖的发生率。
PROSPERO，CRD42017071926。
