Dipartimento di Scienze della Salute, Università degli Studi di Milano, Ospedale San Paolo, Via Antonio di Rudinì 8, 20142, Milan, Italy.
IRCCS MultiMedica, Milan, Italy.
Acta Diabetol. 2020 Jun;57(6):743-749. doi: 10.1007/s00592-020-01483-y. Epub 2020 Feb 6.
Glucagon is used to resolve severe hypoglycemia in unconscious patients with diabetes, requiring third-party assistance. A few studies have shown that intranasal (IN) glucagon causes resolution of hypoglycemia in insulin-treated patients with type 1 (T1DM) diabetes. This systematic review and meta-analysis updates the comparison of the effectiveness of IN glucagon with injected intramuscular/subcutaneous (IM/SC) glucagon in treatment of hypoglycemia in T1DM.
Controlled randomized studies were considered; eight studies, published in English, were included in a meta-analysis (random-effects model). Intervention effect (resolution of hypoglycemia) was expressed as odds ratio (OR), with 95% confidence intervals. Meta-regression was employed to correlate the effect with size of studies, age of patients, basal blood glucose levels.
In a total of 467 treatments in 269 patients with IN and IM/SC glucagon, the OR IN versus IM/SC was 0.61 (CI 0.13-2.82); since four of eight studies showed 100% effectiveness, a simulation was made with 1 failure for each treatment; in this simulation analysis, the OR was 0.80 (95% CI 0.28-2.32). Heterogeneity was low and not statistically significant. Publication bias was absent, and quality of papers was high. At meta-regression, no correlation was found between the effect and number of patients in each study, age of patients, basal blood glucose levels. No study formally compared IN versus IM/SC in unconscious patients.
This meta-analysis indicates that in conscious T1DM patients IN glucagon and IM/SC glucagon are equally effective in resolution of hypoglycemia.
胰高血糖素用于解决伴有糖尿病的无意识患者的严重低血糖，需要第三方协助。一些研究表明，鼻内（IN）给予胰高血糖素可使 1 型（T1DM）糖尿病接受胰岛素治疗的患者的低血糖得到缓解。本系统评价和荟萃分析更新了 IN 胰高血糖素与注射肌肉内/皮下（IM/SC）胰高血糖素在治疗 T1DM 低血糖方面的有效性比较。
考虑了对照随机研究；纳入了八项发表于英文期刊的研究进行荟萃分析（随机效应模型）。干预效果（低血糖缓解）表示为比值比（OR），置信区间为 95%。采用荟萃回归分析将效果与研究规模、患者年龄、基础血糖水平相关联。
在 IN 和 IM/SC 胰高血糖素共 467 次治疗中，269 例患者的 OR IN 与 IM/SC 为 0.61（CI 0.13-2.82）；由于八项研究中有四项显示 100%有效，因此对每种治疗方案模拟了一次失败；在此模拟分析中，OR 为 0.80（95%CI 0.28-2.32）。异质性低且无统计学意义。不存在发表偏倚，且论文质量较高。荟萃回归分析未发现效果与每项研究中的患者数量、患者年龄、基础血糖水平之间存在相关性。没有研究正式比较 IN 与 IM/SC 在无意识患者中的应用。
本荟萃分析表明，在意识清醒的 T1DM 患者中，IN 胰高血糖素和 IM/SC 胰高血糖素在缓解低血糖方面同样有效。
