慢性胰腺炎并发糖尿病患者的循证治疗

目的针对慢性胰腺炎随访中新发糖尿病的患者，展开最佳治疗证据的检索，指导胰源性糖尿病的治疗。方法计算机检索MEDLINE、EMBASE、Cochrane图书馆、CBMdisc、万方数据库和中国知网数据库，寻找胰源性糖尿病的治疗指南、系统评价、临床研究、文献综述等证据，并对所获证据进行分析评价。结果目前尚无胰源性糖尿病的诊治指南，胰源性糖尿病的治疗目标与其他类型糖尿病一致，治疗方法包括基础营养治疗、口服降糖药物和强化胰岛素治疗。降糖药物与胰岛素运用上存在一定分歧，强化胰岛素可能增加了发生胰腺癌的风险，而二甲双胍降低了这种可能性。结论胰源性糖尿病的治疗需采取综合措施，强调患者对血糖监测的依从性．避免严重低血糖的发生．同时做好早期胰腺肿瘤的检测。

Evidence-Based Treatment for Chronic Pancreatitis Patient with New Onset Diabetes

Objective To formulate an individualized evidence-based treatment for a chronic pancreatitis patient with new onset diabetes. Methods We attempted to get the evidences of treatments in pancreatic diabetes, which induced by chronic pancreatitis, by searching MEDLINE, EMBASE, Cochrane library, CBM disc, Wanfang data and CNKI. The evidences were collected and critically assessed after the clinical issues were put forward. Results No clinical guideline was available for the treatment of pancreatic diabetes. With the same purpose of treatment in other types of diabetes, treatments of pancreatic diabetes included basic nutrition therapy, oral agencies for blood glucose control and intensive insulin therapy. Discussions of the use of antidiabetic drugs and insulin were ongoing, and different opinions were detected. Insulin might increase the risk of pancreatic cancer, while metformin reduced this possibility. Conclusion Comprehensive measures should be taken in the management of pancreatic diabetes. Intensive insulin therapy should be applied to patients with high compliance, and avoid the occurrence of severe hypoglycemia. Meanwhile, early tumor detection should be especially noticed with pancreatic diabetes.