Effect of the approach to insulin therapy on glycaemic fluctuations and autonomic tone in hospitalized patients with diabetes.
Effect of the approach to insulin therapy on glycaemic fluctuations and autonomic tone in hospitalized patients with diabetes.
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DOI：
10.1111/dom.12069
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发表时间：
2013-06
期刊：
影响因子：
--
通讯作者：
Binkley P
中科院分区：
文献类型：
--
作者：
Dungan KM;Osei K;Sagrilla C;Binkley P
血糖变异性(GV)与急性疾病患者的死亡率有关，但其机制尚不清楚。这项研究的目的是确定常用的胰岛素治疗方法是否对GV和自主神经张力有明显影响。住院的糖尿病患者被随机分为短期静脉注射(IV)或生理皮下注射(SQ)胰岛素。心率变异性(HRV)和心阻抗(PEP)分别用于评估副交感神经张力和交感神经张力。用连续血糖监测仪测量GV。在第1天，SQ组(N=16)的平均血糖比IV组(N=17)低(10.5vs.8.6 mmol/L，p=0.05)，但在停止输液的过程中变得不明显。血糖不稳定指数(GLI)、持续重叠净血糖作用(COMA)和变异系数(CV)在第1天无差异，但到第2天，IV组这些指标均高于IV组(均P<；0.05)。SQ组的PEP在干预期间(110ms比123ms，p=0.02)和干预后(104ms比126ms，p=0.004)明显升高。两组患者的低血糖情况相似。心率变异性仅有微小差异。治疗后PEP与对数血糖指数呈负相关(r=−0.4 1，p=0.0 3)，与其他指标无相关性。与最佳SQ胰岛素相比，短期静脉注射胰岛素与多个GV指标的增加有关。然而，GLI是预测PEP的唯一指标。需要进一步的研究来确定将GV降至最低的干预措施是否会改善医院的预后。
Glycemic variability (GV) is associated with mortality in acutely ill patients, but the mechanism is unknown. The objective of this study is to determine whether common approaches to insulin therapy have distinct effects on GV and autonomic tone. Hospitalized patients with diabetes were randomized to short-term intravenous (IV) or physiologic subcutaneous (SQ) insulin. Heart rate variability (HRV) and cardiac impedance (pre-ejection period, PEP) were used to estimate parasympathetic and sympathetic tone respectively. GV was measured using a continuous glucose monitor. Mean glucose tended to be lower initially in the SQ group (N=16) compared to the IV group (N=17) on day 1 (10.5 vs. 8.6mmol/l, p=0.05), but became nonsignificant during the transition off of the infusion. There was no difference in glycemic lability index (GLI), continuous overlapping net glycemic action (CONGA) or coefficient of variation (CV) on day 1, but by day 2, these measures were higher in the IV group (p<0.05 for all). PEP was higher in the SQ group during (110 vs. 123 ms, p=0.02) and after the intervention (104 vs. 126 ms, p=0.004). Hypoglycemia was similar in both groups. There were only small differences in HRV. Post-treatment PEP was inversely correlated with log GLI (r= −0.41, p=0.03) but not other measures. Short-term IV insulin is associated with an increase in multiple GV measures compared to optimal SQ insulin. However, GLI was the only predictor of PEP. Further research is needed to determine if interventions that minimize GV improve outcomes in the hospital.
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