Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Endocrinology, Diabetes, & Metabolism, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Endocr Pract. 2022 Aug;28(8):774-779. doi: 10.1016/j.eprac.2022.05.002. Epub 2022 May 10.
To determine the optimal insulin-to-steroid dose ratio for the attainment of glycemic control in hospitalized patients.
We retrospectively studied data collected from the electronic health records within an academic medical center from 18 599 patient-days where patients were treated concurrently with insulin and steroids. Multivariate logistic regression analyses, which included demographic and clinical variables, were performed to assess the relationships between the exposures of total and basal insulin-to-steroid ratios and the outcomes of glycemic control (all blood glucose readings on the following patient-day were >70 and ≤180 mg/dL) and hypoglycemia within 3 subgroups of steroid dosing: low (≤10-mg prednisone equivalent dose [PED]), medium (from >10-mg to ≤40-mg PED), and high (>40-mg PED).
Increased insulin-to-steroid ratio was associated with increased odds of both glycemic control and hypoglycemia. The optimal total insulin-to-steroid ratio for attaining glycemic control was 0.294 U/kg/10-mg PED in the low-dose subgroup, 0.257 U/kg/10-mg PED in the medium-dose subgroup, and 0.085 U/kg/10-mg PED in the high-dose subgroup. The optimal basal insulin-to-steroid ratio was 0.215 U/kg/10-mg PED in the low-dose subgroup, 0.126 U/kg/10-mg PED in the medium-dose subgroup, and 0.036 U/kg/10-mg PED in the high-dose subgroup.
Increasing insulin-to-steroid ratios are positively associated with glycemic control and hypoglycemia. Our study suggests that approximately 0.3 U/kg/10-mg PED is an optimal dose for low- and medium-dose steroids, whereas approximately 0.1 U/kg/10-mg PED is an optimal dose for high-dose steroids. Further prospective studies are needed to identify insulin regimens that will optimize glycemic control in steroid-treated patients while minimizing the risk of hypoglycemia.
确定使住院患者血糖控制达标所需的胰岛素与类固醇剂量比的最佳值。
我们回顾性分析了一家学术医疗中心电子病历中的数据，共纳入 18599 名患者，这些患者在住院期间同时接受胰岛素和类固醇治疗。采用多变量逻辑回归分析，纳入了人口统计学和临床变量，以评估总胰岛素与类固醇剂量比和基础胰岛素与类固醇剂量比暴露与血糖控制（次日所有血糖读数均＞70 且≤180mg/dL）和 3 个类固醇剂量亚组（低剂量[≤10mg 泼尼松等效剂量（PED）]、中剂量[＞10mg 至≤40mg PED]和高剂量[＞40mg PED]）内低血糖的关系。
胰岛素与类固醇剂量比增加与血糖控制和低血糖的发生几率增加均相关。在低剂量亚组中，达到血糖控制的最佳总胰岛素与类固醇剂量比为 0.294U/kg/10mg PED，在中剂量亚组中为 0.257U/kg/10mg PED，在高剂量亚组中为 0.085U/kg/10mg PED。在低剂量亚组中，达到血糖控制的最佳基础胰岛素与类固醇剂量比为 0.215U/kg/10mg PED，在中剂量亚组中为 0.126U/kg/10mg PED，在高剂量亚组中为 0.036U/kg/10mg PED。
胰岛素与类固醇剂量比增加与血糖控制和低血糖呈正相关。本研究表明，对于低剂量和中剂量类固醇，约 0.3U/kg/10mg PED 是一个最佳剂量，而对于高剂量类固醇，约 0.1U/kg/10mg PED 是一个最佳剂量。需要进一步的前瞻性研究来确定胰岛素方案，以在最小化低血糖风险的同时使接受类固醇治疗的患者血糖控制达到最佳。
