Hilsted J C, Madsbad S, Rasmussen M H, Hvidberg A, Krarup T, Ipsen H, Hansen B, Pedersen M, Djurup R, Oxenbøll B
Medicinsk endokrinologisk afdeling, Hvidovre Hospital.
Ugeskr Laeger. 1996 Jun 10;158(24):3451-5.
Metabolic control, hypoglycaemia frequency and nasal mucosal physiology were evaluated in 31 insulin-dependent diabetics treated with intranasal insulin at mealtimes for one month and with subcutaneous fast-acting insulin for another month in a randomized crossover trial. During both periods the patients were treated with intermediate-acting insulin at bedtime. Six of the patients were withdrawn from the study during intranasal insulin therapy due to metabolic dysregulation. Insulin concentrations increased more rapidly and decreased more quickly during intranasal as compared with subcutaneous insulin administration. Metabolic control, assessed by haemoglobin A1c concentrations, deteriorated after intranasal as compared with subcutaneous insulin therapy. The bioavailability of intranasally applied insulin was low, since intranasal insulin doses were approximately 20 times higher than subcutaneous doses. The frequency of hypoglycemia was similar during intranasal and subcutaneous insulin therapy, and nasal mucosal physiology was unaffected after intranasal insulin. We conclude that due to low bioavailability and to a high rate of therapeutic failure, intranasal insulin treatment is not a realistic alternative to subcutaneous insulin injections at the present time.
在一项随机交叉试验中，对31名胰岛素依赖型糖尿病患者进行了评估，这些患者在进餐时接受鼻内胰岛素治疗一个月，然后接受皮下速效胰岛素治疗一个月，同时在两个时期的睡前均接受中效胰岛素治疗。在鼻内胰岛素治疗期间，有6名患者因代谢失调退出研究。与皮下注射胰岛素相比，鼻内注射胰岛素时胰岛素浓度升高更快，下降也更快。与皮下胰岛素治疗相比，通过糖化血红蛋白浓度评估的代谢控制在鼻内胰岛素治疗后恶化。鼻内应用胰岛素的生物利用度较低，因为鼻内胰岛素剂量约为皮下剂量的20倍。鼻内和皮下胰岛素治疗期间低血糖发生频率相似，鼻内胰岛素治疗后鼻粘膜生理功能未受影响。我们得出结论，由于生物利用度低和治疗失败率高，目前鼻内胰岛素治疗并非皮下胰岛素注射的现实替代方案。
