Ogiso Kazuma, Koriyama Nobuyuki, Obo Takahiko, Tokito Akinori, Ueno Takayuki, Nishio Yoshihiko
1Department of Diabetes and Endocrine Medicine, National Hospital Organization Kagoshima Medical Center, 8-1 Shiroyama-cho, Kagoshima, 892-0853 Japan.
2Department of Diabetes and Endocrine Medicine, Kagoshima University Graduate School of Medical and Dental Science, 8-35-1 Sakuragaoka, Kagoshima, 890-8520 Japan.
Diabetol Int. 2018 Jun 15;10(1):12-23. doi: 10.1007/s13340-018-0358-y. eCollection 2019 Jan.
Most previous insulin infusion protocols are titrated for Westerners and are not simple to follow. In this study, we tested the efficacy and safety of our simple insulin infusion protocol utilizing lower insulin doses for Asians.
A total of 152 patients with type 2 diabetes undergoing cardiothoracic surgery were included. After surgery, blood glucose (BG) was initially managed according to our algorithm protocol, and subsequently by the post-algorithm protocol. Insulin infusion rates in the algorithm protocol were titrated in two steps according to (1) current BG levels and (2) the difference between current and previous BG levels. In the post-algorithm protocol, insulin lispro was injected subcutaneously in addition to intravenous insulin infusion according to BG levels. The efficacy was assessed as achievement rates of two target BG ranges (140-199 and 80-199 mg/dL), and safety was assessed as hypoglycemia (< 70 mg/dL) and protocol error rates.
With the use of the algorithm protocol, 58.7% of 1749 BG measurements achieved a range of 140-199 mg/dL, and 95.9% achieved levels within the 80-199 mg/dL range. Hypoglycemia and protocol error rates were 0.47 and 0.51%, respectively. With the post-algorithm protocol, 48.7 and 98.3% of 898 BG measurements achieved each target range. Hypoglycemia and protocol error rates were 0.78 and 0.22%, respectively. Severe hypoglycemia (< 40 mg/dL) was not observed.
Our insulin infusion protocol seems to be efficacious, safe, and widely feasible for Asian patients because of its simplicity and lower insulin dose.
以往大多数胰岛素输注方案是针对西方人制定的，操作起来并不简单。在本研究中，我们测试了一种简单的胰岛素输注方案对亚洲人使用较低胰岛素剂量的有效性和安全性。
共纳入152例接受心胸外科手术的2型糖尿病患者。术后，血糖（BG）最初按照我们的算法方案进行管理，随后按照算法后方案进行管理。算法方案中的胰岛素输注速率根据（1）当前BG水平和（2）当前与先前BG水平之间的差值分两步进行滴定。在算法后方案中，除了根据BG水平进行静脉胰岛素输注外，还皮下注射赖脯胰岛素。有效性评估为两个目标BG范围（140 - 199和80 - 199mg/dL）的达标率，安全性评估为低血糖（<70mg/dL）和方案错误率。
使用算法方案时，1749次BG测量中有58.7%达到了140 - 199mg/dL的范围，95.9%达到了80 - 199mg/dL的水平。低血糖和方案错误率分别为0.47%和0.51%。使用算法后方案时，898次BG测量中有48.7%和98.3%达到了每个目标范围。低血糖和方案错误率分别为0.78%和0.22%。未观察到严重低血糖（<40mg/dL）。
我们的胰岛素输注方案因其简单性和较低的胰岛素剂量，对亚洲患者似乎是有效、安全且广泛可行的。
