Wei Jie, Wang Yueer
Department of Pediatrics, The First People's Hospital of Huzhou, First Affiliated Hospital of Huzhou Normal University, Huzhou 313000, Zhejiang Province, China.
Department of Outpatient, The First People's Hospital of Huzhou, First Affiliated Hospital of Huzhou Normal University, Huzhou 313000, Zhejiang Province, China.
Iran J Public Health. 2024 Jan;53(1):23-34. doi: 10.18502/ijph.v53i1.14680.
Intensive insulin regimens are recommended to achieve glycemic goals in children and adolescents with type 1 diabetes. Fast-acting insulin aspart (faster aspart) is a new formulation of insulin aspart (IAsp) in which L-arginine and niacinamide are added to assure formulation stability, early absorption, and ultra-fast action. This meta-analysis compares faster aspart with IAsp for blood sugar control in children with type 1 diabetes. This study suggested treating diabetes with insulin, especially in children with type 1 diabetes.
PubMed, MEDLINE, Embase, Cochrane Library, Web of Science, and Google Scholar were searched from 2000 to 2023 without language restrictions. Blood glucose monitoring, HbA1c, care model, insulin aspart, IAsp, faster aspart, type 1 diabetes, and pediatrics are Mesh keywords. Cochrane Q statistics and index tested heterogeneity. To account for heterogeneity, Q=145.99 (-value < 0.001) and =97.26%, and the random-effect model was used to aggregate primary study results. The meta-analysis of randomized-controlled trials was conducted in accordance with PRISMA standards.
The overall estimate measure i.e. mean difference was found to be 5.44 [0.45, 10.44] and 7.71 [7.16, 8.26] which indicate significant reduction in the HbA1C level in the fast acting insulin aspart group as compared to the IAsp in T1D. However, the mean difference with respect to BMI was found to be -0.06 [-0.60, 0.48] which indicate non-significant reduction.
Faster aspart had faster onset and more early exposure than IAsp in children and adolescents with greater and more variable anti-insulin antibody levels than adults did. Hence fast-acting insulin aspart may provide better glucose control than IAsp in T1D.
推荐采用强化胰岛素治疗方案，以实现1型糖尿病儿童和青少年的血糖目标。速效门冬胰岛素（更快起效的门冬胰岛素）是门冬胰岛素（IAsp）的一种新制剂，其中添加了L-精氨酸和烟酰胺，以确保制剂稳定性、早期吸收和超快速作用。本荟萃分析比较了更快起效的门冬胰岛素与IAsp对1型糖尿病儿童血糖控制的效果。本研究提示用胰岛素治疗糖尿病，尤其是1型糖尿病儿童。
检索2000年至2023年的PubMed、MEDLINE、Embase、Cochrane图书馆、科学网和谷歌学术，无语言限制。血糖监测、糖化血红蛋白、护理模式、门冬胰岛素、IAsp、更快起效的门冬胰岛素、1型糖尿病和儿科学是主题词。采用Cochrane Q统计量和I²指数检验异质性。为解释异质性，Q = 145.99（P值<0.001），I² = 97.26%，采用随机效应模型汇总主要研究结果。按照PRISMA标准进行随机对照试验的荟萃分析。
总体估计量即平均差分别为5.44 [0.45, 10.44]和7.71 [7.16, 8.26]，这表明与IAsp相比，速效门冬胰岛素组的糖化血红蛋白水平在1型糖尿病中显著降低。然而，体重指数的平均差为-0.06 [-0.60, 0.48]，表明降低不显著。
在抗胰岛素抗体水平比成人更高且更具变异性的儿童和青少年中，更快起效的门冬胰岛素比IAsp起效更快且早期暴露更多。因此，速效门冬胰岛素在1型糖尿病中可能比IAsp提供更好的血糖控制。
