Nathan D M, Lou P, Avruch J
Ann Intern Med. 1982 Jul;97(1):31-6. doi: 10.7326/0003-4819-97-1-31.
We examined the relative efficacy of two modes of insulin therapy in five patients with insulin-dependent diabetes. Using a crossover protocol, therapy with multiple insulin injections was compared with the use of continuous subcutaneous insulin infusion (pump therapy); both therapies were regulated by home blood glucose monitoring. Although both therapies were equally effective during 2 to 4 days of inpatient management, pump therapy was clearly superior in the outpatient setting. Mean plasma glucose and hemoglobin A1c concentrations and the frequency of hypoglycemic reactions were significantly less with pump therapy despite apparently equal compliance with both therapies. We conclude that in compliant adult patients with type I diabetes continuous insulin infusion is more effective in achieving normalization of plasma glucose concentration than intensified conventional therapy in the outpatient setting. Although these patients found pump therapy preferable to intensive conventional therapy, the superiority of pump therapy is not explained by this bias. Whether these results are applicable in a more standard treatment setting remains to be established.
我们研究了两种胰岛素治疗方式对五名胰岛素依赖型糖尿病患者的相对疗效。采用交叉试验方案，将多次胰岛素注射治疗与持续皮下胰岛素输注（胰岛素泵治疗）进行比较；两种治疗均通过家庭血糖监测进行调整。尽管在住院治疗的2至4天内两种治疗同样有效，但在门诊环境中胰岛素泵治疗明显更优。尽管两种治疗的依从性看似相同，但胰岛素泵治疗的平均血浆葡萄糖和糖化血红蛋白A1c浓度以及低血糖反应的频率显著更低。我们得出结论，在依从性良好的成年I型糖尿病患者中，在门诊环境下持续胰岛素输注在实现血浆葡萄糖浓度正常化方面比强化传统治疗更有效。尽管这些患者认为胰岛素泵治疗优于强化传统治疗，但胰岛素泵治疗的优越性并非由此偏差所致。这些结果是否适用于更标准的治疗环境仍有待确定。
