Butkiewicz E K, Leibson C L, O'Brien P C, Palumbo P J, Rizza R A
Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota 55905, USA.
Diabetes Care. 1995 Aug;18(8):1187-90. doi: 10.2337/diacare.18.8.1187.
Despite widespread acceptance of continuous insulin infusion (CII) over bolus insulin injection (BII) for treatment of diabetic ketoacidosis (DKA), there are no population-based studies demonstrating whether CII has resulted in lower morbidity and mortality.
We addressed this issue using a provider-linked database and retrospectively reviewing the complete medical records of all incidence cases of diabetes among Rochester, Minnesota, residents from 1950 to 1989 with a discharge diagnosis of DKA. This population-based study describes the consequences of the widespread change in treatment modality outside the confines of a controlled clinical trial.
Among the diabetes incident cohort, there were 59 subjects with confirmed first episodes of DKA during 1950-1992; 29 of 30 subjects treated with BII occurred before 1970. All 29 CII cases occurred between 1976 and 1992. Sex, etiology, diabetes duration, and age at DKA were similar for the two groups. The proportion of obese individuals (BII = 2/28, CII = 8/21; P = 0.01) differed between groups. The CII group exhibited higher glucose values (BII = 24.9 +/- 8.5 mmol/l, CII = 37.1 +/- 15.1 mmol/l; P = 0.002) and lower bicarbonate values (BII = 7.7 +/- 3.0 nmol/l, CII = 6.2 +/- 2.9 nmol/l; P = 0.04) upon admission. The mean quantity of insulin administered was higher in the BII group than in the CII group (179 +/- 140 and 99 +/- 70 U, P < 0.006). The outcome of hypoglycemia occurred more frequently in the BII group than in the CII group (BII = 8/30, CII = 1/29; P = 0.03). The proportion with hypokalemia, neurological deficit, myocardial arrhythmia, or mortality did not differ significantly between groups.
Our findings suggest the introduction of CII was accompanied by a decreased incidence of hypoglycemia.
尽管在糖尿病酮症酸中毒（DKA）治疗中，持续胰岛素输注（CII）较胰岛素推注（BII）已得到广泛认可，但尚无基于人群的研究表明CII是否能降低发病率和死亡率。
我们利用一个与医疗服务提供者相关的数据库，回顾性地查阅了明尼苏达州罗切斯特市1950年至1989年所有出院诊断为DKA的糖尿病发病病例的完整医疗记录。这项基于人群的研究描述了在对照临床试验范围之外治疗方式广泛改变的后果。
在糖尿病发病队列中，1950 - 1992年间有59例确诊为首次发生DKA的患者；30例接受BII治疗的患者中有29例发生在1970年之前。所有29例CII治疗病例均发生在1976年至1992年之间。两组患者的性别、病因、糖尿病病程以及发生DKA时的年龄相似。两组肥胖个体的比例不同（BII组 = 2/28，CII组 = 8/21；P = 0.01）。CII组入院时血糖值较高（BII组 = 24.9 ± 8.5 mmol/L，CII组 = 37.1 ± 15.1 mmol/L；P = 0.002），碳酸氢盐值较低（BII组 = 7.7 ± 3.0 nmol/L，CII组 = 6.2 ± 2.9 nmol/L；P = 0.04）。BII组给予的胰岛素平均量高于CII组（179 ± 140和99 ± 70 U，P < 0.006）。BII组低血糖结局的发生率高于CII组（BII组 = 8/30，CII组 = 1/29；P = 0.03）。两组低钾血症、神经功能缺损、心律失常或死亡率的比例无显著差异。
我们的研究结果表明，引入CII后低血糖的发生率有所降低。
