From the McGill University Health Centre.
Hospital Central "Dr. Ignacio Morones Prieto".
Plast Reconstr Surg. 2023 Dec 1;152(6):1114e-1130e. doi: 10.1097/PRS.0000000000010432. Epub 2023 Mar 21.
Wounds are a significant health issue, and reliable and safe strategies to promote repair are needed. Clinical trials have demonstrated that local insulin promotes healing in acute and chronic wounds (ie, reductions of 7% to 40% versus placebo). However, the trials' sample sizes have prevented drawing solid conclusions. Furthermore, no analysis has focused on safety concerns (ie, hypoglycemia). Under the hypothesis that local insulin promotes healing through proangiogenic effects and cellular recruitment, the aim of this systematic review and network meta-analysis (NMA) was to assess its safety and relative effectiveness using a Bayesian approach.
Medline, CENTRAL, Embase, Scopus, LILACS, and gray literature sources were searched for human studies assessing the local use of insulin versus any comparator since inception to October of 2020. Data on glucose changes and adverse events, wound and treatment characteristics, and healing outcomes were extracted, and an NMA was conducted.
A total of 949 reports were found, of which 23 ( n = 1240 patients) were included in the NMA. The studies evaluated six different therapies, and most comparisons were against placebo. NMA showed -1.8 mg/dL blood glucose level change with insulin and a lack of reported adverse events. Statistically significant clinical outcomes identified include reduction in wound size (-27%), increased healing rate (23 mm/day), reduction in Pressure Ulcer Scale for Healing scores (-2.7), -10 days to attain complete closure, and an odds ratio of 20 for complete wound closure with insulin use. Likewise, significantly increased neoangiogenesis (+30 vessels/mm 2 ) and granulation tissue (+25%) were also found.
Local insulin promotes wound healing without significant adverse events.
伤口是一个严重的健康问题，需要可靠和安全的策略来促进修复。临床试验已经证明，局部胰岛素可以促进急性和慢性伤口的愈合（即与安慰剂相比减少 7%至 40%）。然而，试验的样本量阻止了得出确凿的结论。此外，没有分析关注安全问题（即低血糖）。基于局部胰岛素通过促血管生成作用和细胞募集来促进愈合的假设，本系统评价和网络荟萃分析（NMA）旨在使用贝叶斯方法评估其安全性和相对有效性。
从建库至 2020 年 10 月，检索了 Medline、CENTRAL、Embase、Scopus、LILACS 和灰色文献来源，以评估自成立以来评估局部使用胰岛素与任何对照药物的人类研究。提取了葡萄糖变化和不良事件、伤口和治疗特征以及愈合结局的数据，并进行了 NMA。
共发现 949 份报告，其中 23 份（n=1240 例患者）纳入 NMA。这些研究评估了六种不同的治疗方法，大多数比较都是与安慰剂相比。NMA 显示胰岛素组的血糖水平变化为-1.8 mg/dL，且无不良事件报告。确定的有统计学意义的临床结局包括伤口面积减少（-27%）、愈合速度增加（23mm/天）、压疮愈合评分降低（-2.7）、完全闭合时间减少 10 天以及胰岛素使用时完全闭合的优势比为 20。同样，也发现了明显增加的新生血管形成（+30 个血管/mm2）和肉芽组织（+25%）。
局部使用胰岛素可促进伤口愈合，且无明显不良事件。
