Cao Lu, Zhang Dan, Zhao Ying, Zhou Nan, Zhang Peng
Department of Pharmacy, Shaanxi Provincial People's Hospital, Xi'an, China.
Front Nutr. 2023 Aug 3;10:1181359. doi: 10.3389/fnut.2023.1181359. eCollection 2023.
To systematically evaluate the efficacy and safety of different insulin infusion methods in the treatment of total parenteral nutrition (TPN)-associated hyperglycemia based on published literature and the data of completed clinical trials using a network meta-analysis.
A comprehensive search of PubMed, Elsevier, Web of Science, EMBASE, Medline, clinicaltrials.gov, Cochrane Library, and three Chinese databases (Wanfang Data, China National Knowledge Infrastructure, and SINOMED) up to December 15, 2022, was performed to collect information on different insulin infusion methods used for the treatment of TPN-associated hyperglycemia, and the Cochrane systematic review method was used to screen the literature, evaluate the quality of the included literature, and extract clinical characteristics for a network meta-analysis. Clinical outcomes included mean blood glucose (MBG), hypoglycemia, hospital length of stay, hyperglycemia, surgical site infection (SSI) and mean total daily insulin.
A total of 21 articles, including 1,459 patients, were included to analyze 6 different routes of insulin infusion, including continuous intravenous insulin infusion (CVII), continuous subcutaneous insulin infusion (CSII), subcutaneous glargine insulin (s.c. GI), the addition of regular insulin to the PN mixture (RI-in-PN), multiple subcutaneous insulin injections (MSII) and 50% of insulin administered as RI-in-PN + 50% of insulin administered as s.c. GI (50% RI-in-PN + 50% s.c. GI). The results of the network meta-analysis showed that MSII was the least effective in terms of MBG, followed by CVII. The 6 interventions were basically equivalent in terms of the hypoglycemia incidence. In terms of the length of hospital stay, patients in the CVII group had the shortest hospital stay, while the MSII group had the longest. CVII was the best intervention in reducing the incidence of hyperglycemia. The incidence of SSI was the lowest in the CSII and CVII groups, and the mean daily insulin dosage was the lowest in the CVII group.
Current literature shows that for the treatment of TPN-associated hyperglycemia, CVII is the most effective, reducing the incidence of hyperglycemia and shortening the length of hospital stay without increasing the incidence of hypoglycemia. MSII has the worst efficacy, leading to a higher MBG and longer hospital stay, and RI-in-PN, CSII, s.c. GI and 50% RI-in-PN + 50% s.c. GI are better in terms of efficacy and safety and can be substituted for each other.
https://www.crd.york.ac.uk/prospero/, identifier CRD42023439290.
基于已发表的文献和完成的临床试验数据，采用网状Meta分析系统评价不同胰岛素输注方法治疗全胃肠外营养（TPN）相关高血糖的疗效和安全性。
全面检索截至2022年12月15日的PubMed、Elsevier、Web of Science、EMBASE、Medline、clinicaltrials.gov、Cochrane图书馆以及三个中文数据库（万方数据、中国知网和维普资讯），收集用于治疗TPN相关高血糖的不同胰岛素输注方法的信息，并采用Cochrane系统评价方法筛选文献、评估纳入文献的质量，提取临床特征进行网状Meta分析。临床结局包括平均血糖（MBG）、低血糖、住院时间、高血糖、手术部位感染（SSI）和平均每日胰岛素总量。
共纳入21篇文章，涉及1459例患者，分析6种不同的胰岛素输注途径，包括持续静脉胰岛素输注（CVII）、持续皮下胰岛素输注（CSII）、皮下注射甘精胰岛素（s.c.GI）、在PN混合液中添加正规胰岛素（RI-in-PN）、多次皮下胰岛素注射（MSII）以及50%胰岛素以RI-in-PN方式给药+50%胰岛素以s.c.GI方式给药（50%RI-in-PN+50%s.c.GI）。网状Meta分析结果显示，就MBG而言，MSII效果最差，其次是CVII。6种干预措施在低血糖发生率方面基本相当。就住院时间而言，CVII组患者住院时间最短，而MSII组最长。CVII是降低高血糖发生率的最佳干预措施。CSII组和CVII组的SSI发生率最低，CVII组的平均每日胰岛素剂量最低。
当前文献表明，对于TPN相关高血糖的治疗，CVII最有效，可降低高血糖发生率并缩短住院时间，且不增加低血糖发生率。MSII疗效最差，导致MBG更高且住院时间更长，RI-in-PN、CSII、s.c.GI和50%RI-in-PN+50%s.c.GI在疗效和安全性方面较好，可相互替代。
