Department of Clinical and Molecular Medicine, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Endocrinology, St. Olav's University Hospital, Trondheim, Norway.
PLoS One. 2021 Apr 13;16(4):e0249611. doi: 10.1371/journal.pone.0249611. eCollection 2021.
The intraperitoneal route of administration accounts for less than 1% of insulin treatment regimes in patients with diabetes mellitus type 1 (DM1). Despite being used for decades, a systematic review of various physiological effects of this route of insulin administration is lacking. Thus, the aim of this systematic review was to identify the physiological effects of continuous intraperitoneal insulin infusion (CIPII) compared to those of continuous subcutaneous insulin infusion (CSII) in patients with DM1. Four databases (EMBASE, PubMed, Scopus and CENTRAL) were searched beginning from the inception date of each database to 10th of July 2020, using search terms related to intraperitoneal and subcutaneous insulin administration. Only studies comparing CIPII treatment (≥ 1 month) with CSII treatment were included. Primary outcomes were long-term glycaemic control (after ≥ 3 months of CIPII inferred from glycated haemoglobin (HbA1c) levels) and short-term (≥ 1 day for each intervention) measurements of insulin dynamics in the systematic circulation. Secondary outcomes included all reported parameters other than the primary outcomes. The search identified a total of 2242 records; 39 reports from 32 studies met the eligibility criteria. This meta-analysis focused on the most relevant clinical end points; the mean difference (MD) in HbA1c levels during CIPII was significantly lower than during CSII (MD = -6.7 mmol/mol, [95% CI: -10.3 --3.1]; in percentage: MD = -0.61%, [95% CI: -0.94 -- 0.28], p = 0.0002), whereas fasting blood glucose levels were similar (MD = 0.20 mmol/L, [95% CI: -0.34-0.74], p = 0.47; in mg/dL: MD = 3.6 mg/dL, [95% CI: -6.1-13.3], p = 0.47). The frequencies of severe hypo- and hyper-glycaemia were reduced. The fasting insulin levels were significantly lower during CIPII than during CSII (MD = 16.70 pmol/L, [95% CI: -23.62 --9.77], p < 0.0001). Compared to CSII treatment, CIPII treatment improved overall glucose control and reduced fasting insulin levels in patients with DM1.
腹腔内给药途径在 1 型糖尿病（DM1）患者的胰岛素治疗方案中占比不到 1%。尽管这种给药途径已经使用了几十年，但缺乏对其各种生理效应的系统评价。因此，本系统评价的目的是确定与连续皮下胰岛素输注（CSII）相比，DM1 患者持续腹腔内胰岛素输注（CIPII）的生理效应。从每个数据库的创建日期开始，在 2020 年 7 月 10 日之前，使用与腹腔内和皮下胰岛素给药相关的搜索词，在 4 个数据库（EMBASE、PubMed、Scopus 和 CENTRAL）中进行了检索。仅纳入了比较 CIPII 治疗（≥1 个月）与 CSII 治疗的研究。主要结局是长期血糖控制（从 HbA1c 水平推断≥3 个月的 CIPII）和系统循环中短期（每种干预措施≥1 天）胰岛素动力学的测量。次要结局包括除主要结局以外的所有报告参数。检索共确定了 2242 条记录；32 项研究的 39 份报告符合入选标准。这项荟萃分析重点关注最相关的临床终点；CIPII 期间的 HbA1c 水平平均差值（MD）明显低于 CSII（MD=-6.7mmol/mol，[95%CI：-10.3--3.1]；百分比：MD=-0.61%，[95%CI：-0.94--0.28]，p=0.0002），而空腹血糖水平相似（MD=0.20mmol/L，[95%CI：-0.34-0.74]，p=0.47；mg/dL：MD=3.6mg/dL，[95%CI：-6.1-13.3]，p=0.47）。严重低血糖和高血糖的发生频率降低。CIPII 期间的空腹胰岛素水平明显低于 CSII（MD=16.70pmol/L，[95%CI：-23.62--9.77]，p<0.0001）。与 CSII 治疗相比，CIPII 治疗改善了 1 型糖尿病患者的整体血糖控制并降低了空腹胰岛素水平。
