胰岛素泵与多次胰岛素强化治疗初发2型糖尿病患者的系统评价

目的系统评价胰岛素泵和多次胰岛素注射治疗初发2型糖尿病患者的疗效。方法计算机检索MEDLINE和中国全文期刊网（从建库截至2009年12月）所有胰岛素泵和多次胰岛素注射治疗初发2型糖尿病患者的随机对照试验。由两位评价者按纳入排除标准独立进行质量评价和资料提取,并交叉核对,然后采用RevMan 5.0.23软件进行Meta分析。评价指标包括：血糖控制、胰岛素用量、胰岛素抵抗指数（HOMA-IR）、胰岛素分泌指数（HOMA-β）、低血糖发生率和糖尿病缓解率。结果共纳入8个随机对照试验,597例新诊断的2型糖尿病患者。除1个试验外,其他纳入试验的方法学质量均为B级。以胰岛素需要量和糖尿病缓解率为结局指标的漏斗图提示存在发表偏倚。Meta分析结果显示：胰岛素泵治疗和多次胰岛素注射治疗均能控制空腹血糖WMD=–0.21,95%CI（–0.42,0.00）,P=0.05]和餐后血糖WMD=–0.24,95%CI（–0.57,0.08）,P=0.14]。胰岛素泵治疗使血糖达标所需时间更少,比多次胰岛素注射治疗大约少2.74天WMD=–2.74,95%CI（–3.33,–2.16）,P〈0.000 01];且所需胰岛素量更少,约少7.78单位WMD=–7.78,95%CI（–9.25,–6.31）,P〈0.000？01]。胰岛素泵治疗组低血糖发生率明显低于胰岛素多次注射组,约减少了69%OR=0.31,95%CI（0.12,0.80）,P=0.01];而糖尿病缓解率比多次胰岛素注射组增加约46%OR=1.46,95%CI（1.01,2.10）,P=0.04]。结论对于新诊断的2型糖尿病患者胰岛素泵治疗效果优于多次胰岛素注射治疗。但因纳入研究的质量不高,在临床应用时应结合患者情况和医生经验,权衡利弊后使用。

Contimuous Subcutaneous Insulin Infusion versus Multiple Daily Insulin Injections in Patients with Newly Diagnosed Type 2 Diabetes Mellitus: A Systematic Review

Objective To compare the effect of continuous subcutaneous insulin infusion（CSII）with that of multiple daily insulin injections（MDI）in the patients with newly-diagnosed type 2 diabetes,and to provide evidence for clinical treatment.Methods We searched MEDLINE and Chinese Science and Technology Full-text Database up to Dec.2009 to identify randomized controlled trials（RCTs）that had been conducted with patients with newly diagnosed type 2 diabetes mellitus.The selection of studies,data extraction and assessment of methodological quality were performed independently by two reviewers.Meta-analyses were performed using RevMan 5.0.23 software.The following outcomes were assessed：glycaemic control,insulin requirements,HOMA-IR,HOMA-β,hypoglycaemia and diabetic remission after follow-up.Results Eight RCTs involving 597 newly-diagnosed type 2 diabetic patients were included.The methodological quality of the most studies was lower.The funnel plot comparing insulin requirement of CSII therapy with that of MDI therapy showed asymmetry,indicating that there was publication bias.The results of meta-analyses showed that：CSII had the same effect on improving fasting blood glucose（WMD= –0.21,95%CI –0.42 to 0.00,P=0.05）and postprandial blood glucose（WMD= –0.24,95CI% –0.57 to 0.08,P=0.14）as MDI in newly-diagnosed type 2 diabetes.CSII therapy took 2.74 days fewer than MDI therapy（WMD= –2.74,95CI% –3.33 to –2.16,P0.000 01）and needed lower insulin requirements（reducing 7.78 units per day）（WMD= –7.78,95CI% –9.25 to –6.31,P0.000 01）to get target glucose control.The rate of hypoglycaemia of CSII therapy decreased 69%（OR= 0.31,95%CI 0.12 to 0.80,P=0.01）compared with that of MDI.The rate of diabetes remission after short-term intensive insulin therapy increased 46%（OR=1.46,95%CI 1.01 to 2.10,P=0.04）in CSII therapy compared with that in MDI therapy.Conclusion In newly-diagnosed type 2 diabetes,CSII therapy is better than MDI therapy.But because of the low quality of the included studies,the conclusion should be combined with patients and physicians＇ experience,advantages and disadvantages in the clinical application.