Sliding-Scale versus Basal-Bolus Insulin in the Management of Severe or Acute Hyperglycemia in Type 2 Diabetes Patients: A Retrospective Study
Sliding-Scale versus Basal-Bolus Insulin in the Management of Severe or Acute Hyperglycemia in Type 2 Diabetes Patients: A Retrospective Study
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DOI：
10.1371/journal.pone.0106505
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发表时间：
2014-09-02
期刊：
影响因子：
3.7
通讯作者：
Vethakkan, Shireene Ratna
中科院分区：
文献类型：
--
作者：
Huri, Hasniza Zaman;Permalu, Vishaaliny;Vethakkan, Shireene Ratna
滑动标尺和基础-餐时胰岛素方案是治疗2型糖尿病患者严重或急性高血糖的两种选择。虽然不推荐使用，但滑动标度胰岛素治疗仍被广泛使用。本研究的目的是比较使用滑动标尺或基础-餐时方案管理2型糖尿病患者重度或急性高血糖所实现的血糖控制，并分析与用于管理重度或急性高血糖的胰岛素治疗类型相关的因素。这项回顾性研究使用了2008年1月至2012年12月在马来西亚一家医院住院的急性或重度高血糖患者的病历。共纳入202例患者和247例住院患者。基础-餐时胰岛素方案治疗患者的空腹血糖（10.8 +/- 2.3 vs 11.6 +/- 3.5 mmol/L; p = 0.028）和重度/急性高血糖期间的平均血糖水平（12.3 +/- 1.9 vs 12.8 +/- 2.2; p = 0.021）低于滑动标度胰岛素方案。糖尿病酮症酸中毒（p = 0.043）、心血管疾病（p = 0.005）、支气管哮喘急性发作（p = 0.010）、皮质类固醇（p = 0.037）和袢利尿剂（p = 0.016）的使用与所用胰岛素方案的类型显著相关。总之，2型糖尿病患者严重和急性高血糖实现了更好的血糖控制与基础餐时胰岛素方案比滑动标度胰岛素，和相关因素使用的胰岛素方案可以确定。
Sliding-scale and basal-bolus insulin regimens are two options available for the treatment of severe or acute hyperglycemia in type 2 diabetes mellitus patients. Although its use is not recommended, sliding-scale insulin therapy is still being used widely. The aims of the study were to compare the glycemic control achieved by using sliding-scale or basal-bolus regimens for the management of severe or acute hyperglycemia in patients with type 2 diabetes and to analyze factors associated with the types of insulin therapy used in the management of severe or acute hyperglycemia. This retrospective study was conducted using the medical records of patients with acute or severe hyperglycemia admitted to a hospital in Malaysia from January 2008 to December 2012. A total of 202 patients and 247 admissions were included. Patients treated with the basal-bolus insulin regimen attained lower fasting blood glucose (10.8 +/- 2.3 versus 11.6 +/- 3.5 mmol/L; p = 0.028) and mean glucose levels throughout severe/acute hyperglycemia (12.3 +/- 1.9 versus 12.8 +/- 2.2; p = 0.021) compared with sliding-scale insulin regimens. Diabetic ketoacidosis (p = 0.043), cardiovascular diseases (p = 0.005), acute exacerbation of bronchial asthma (p = 0.010), and the use of corticosteroids (p = 0.037) and loop diuretics (p = 0.016) were significantly associated with the type of insulin regimen used. In conclusion, type 2 diabetes patients with severe and acute hyperglycemia achieved better glycemic control with the basal-bolus regimen than with sliding-scale insulin, and factors associated with the insulin regimen used could be identified.