泼尼松龙诱导的高血糖症治疗期间胰岛素需求量的临床决定因素

Clinical determinants of insulin requirements during treatment of prednisolone-induced hyperglycaemia.

作者信息

Chen Angela X, Radhakutty Anjana, Zimmermann Anthony, Stranks Stephen N, Thompson Campbell H, Burt Morton G

机构信息

Department of Endocrinology, Flinders Medical Centre, Bedford Park, Australia; College of Medicine and Public Health, Flinders University, Bedford Park, Australia.

College of Medicine and Public Health, Flinders University, Bedford Park, Australia; Department of Medicine, Lyell McEwin Hospital, Elizabeth Vale, Australia.

出版信息

Diabetes Res Clin Pract. 2023 Mar;197:110557. doi: 10.1016/j.diabres.2023.110557. Epub 2023 Feb 1.

DOI:10.1016/j.diabres.2023.110557

PMID:36736733

Abstract

AIMS

The optimal treatment of prednisolone-associated hyperglycaemia is unclear, but guidelines recommend using a body weight-based daily insulin dose. This study evaluated how clinical variables were associated with insulin requirements in hospitalised patients with prednisolone-associated hyperglycaemia.

METHODS

In this prospective study, fifty adult inpatients who were taking prednisolone ≥20 mg/day and experienced hyperglycaemia were prescribed a 24-h intravenous insulin infusion. The daily insulin dose required to attain a mean glucose of 8 mmol/L was calculated. The associations between daily insulin dose and clinical variables were assessed.

RESULTS

The participants age was 69 ± 10 years, daily prednisolone dose was 34 ± 10 mg, HbA1c was 7.7 ± 2.0 % (61 ± 10 mmol/mol), 77 % had known type 2 diabetes and 30 % were female. In univariate analysis, weight was associated with daily insulin dose (r = 0.11, p = 0.024). A multivariate model comprising sex, HbA1c, a prior diagnosis of diabetes, diabetes treatment and weight explained nearly-two thirds of the variability in daily insulin dose (r = 0.65, p < 0.001).

CONCLUSIONS

In patients with prednisolone-associated hyperglycaemia, calculating insulin doses based on sex, HbA1c, diabetes status and regular diabetes treatment and weight may improve glycaemic control compared to weight-based dosing.

摘要

目的

泼尼松龙相关高血糖的最佳治疗方法尚不清楚，但指南建议使用基于体重的每日胰岛素剂量。本研究评估了住院的泼尼松龙相关高血糖患者的临床变量与胰岛素需求量之间的关系。

方法

在这项前瞻性研究中，五十名每日服用泼尼松龙≥20毫克且出现高血糖的成年住院患者接受了24小时静脉胰岛素输注治疗。计算使平均血糖达到8毫摩尔/升所需的每日胰岛素剂量。评估每日胰岛素剂量与临床变量之间的关系。

结果

参与者年龄为69±10岁，每日泼尼松龙剂量为34±10毫克，糖化血红蛋白为7.7±2.0%（61±10毫摩尔/摩尔），77%患有2型糖尿病，30%为女性。单因素分析中，体重与每日胰岛素剂量相关（r = 0.11，p = 0.024）。一个包含性别、糖化血红蛋白、糖尿病既往诊断、糖尿病治疗情况和体重的多变量模型解释了近三分之二的每日胰岛素剂量变异性（r = 0.65，p < 0.001）。