A comparison of continuous intravenous insulin and subcutaneous insulin among patients with type 2 diabetes and congestive heart failure exacerbation.
A comparison of continuous intravenous insulin and subcutaneous insulin among patients with type 2 diabetes and congestive heart failure exacerbation.
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2型糖尿病患者和充血性心力衰竭加剧的患者中连续静脉胰岛素和皮下胰岛素的连续胰岛素和皮下胰岛素的比较。
DOI：
10.1002/dmrr.2569
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发表时间：
2015-01
影响因子：
8
通讯作者：
Binkley, Philip
中科院分区：
文献类型：
--
作者：
Dungan, Kathleen M.;Osei, Kwame;Gaillard, Trudy;Moore, Jared;Binkley, Philip
这项研究旨在确定胰岛素给药途径是否影响2型糖尿病(T2D)和充血性心力衰竭(CHF)恶化患者的血糖变异性和炎症或神经激素标记物。患者(N=65)被随机分为静脉注射(IV)胰岛素(持续48小时)或皮下注射(SQ)胰岛素。使用炎症细胞因子和脂质氧化标志物、高频心率变异性(HRV，N=27)和心阻抗(PEP，N=28)来评估有有效心脏资料的患者的副交感和交感神经张力。使用连续血糖监测仪测量血糖变异性。静脉注射组第1天的平均血糖低于SQ组(7.7+/−1.2vs.9.4+/−2.7−/L，p=0.004)，变异系数高于SQ组(p=0.005)，血糖不稳定指数与SQ组相似，但第2天时两组相似。两组之间在再次住院或住院时间方面没有差异。CHF生物标志物、HRV或PEP在组间差异无统计学意义。对数血糖指数的增加与治疗中PEP的降低有关(p=0.004.0 3)，而CV的增加与脑钠素(p=0.0 5)和对氧磷酶-1(p=0.0 2)的升高有关。其他单变量分析并不显著。在住院的CHF患者中，静脉注射胰岛素和SQ胰岛素在血糖控制方面有轻微的、短暂的差异。然而，这些分析并不支持胰岛素途径与炎症标志物或自主神经张力之间的联系。需要进一步的研究来评估住院的CHF患者的预后。
The study aims to determine whether the route of insulin administration influences glycemic variability and inflammatory or neurohormonal markers in patients with type 2 diabetes (T2D) and congestive heart failure (CHF) exacerbation. Patients (N=65) were randomized to intravenous (IV) insulin (duration 48 hours) or subcutaneous (SQ) insulin. Inflammatory cytokines and markers of lipid oxidation; high frequency heart rate variability (HRV, N=27) and cardiac impedance (pre-ejection period, PEP, N=28) were used to estimate parasympathetic and sympathetic tone in patients with valid cardiac data. Glycemic variability was measured using a continuous glucose monitor. Mean glucose was lower (7.7 +/−1.2 vs. 9.4 +/− 2.7 mmol/L, p=0.004), coefficient of variation (CV) was higher (p=0.03), and glycemic lability index (GLI) was similar on day 1 in the IV group compared to the SQ group, but groups were similar by day 2. The IV group had more confirmed hypoglycemia (p=0.005). There were no differences in hospital readmission or hospital length of stay between groups. There were no differences in CHF biomarkers, HRV or PEP between groups. Increasing log GLI was associated with lower on-treatment PEP (p=0.03) while increasing CV was associated with increasing brain natriuretic peptide (BNP, p=0.004) and paroxonase-1 (p=0.02). Other univariable analyses were not significant. There were modest, transient differences in glucose control between IV and SQ insulin in hospitalized CHF patients. However, the analyses do not support a link between insulin route and inflammatory markers or autonomic tone. Further study is needed to assess outcomes in hospitalized CHF patients.
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DOI：
10.1111/dom.12069
发表时间：
2013-06
期刊：
Diabetes, obesity & metabolism
影响因子：
--
作者：
Dungan KM;Osei K;Sagrilla C;Binkley P
通讯作者：
Binkley P
影响因子：
5.8
作者：
Zijlstra, E.;Heise, T.;Heckermann, S.
通讯作者：
Heckermann, S.
DOI：
10.1016/j.numecd.2006.09.006
发表时间：
2007-12-01
影响因子：
3.9
作者：
Santini, Vanina;Ciampittiello, Giuseppina;Frontoni, Simona
通讯作者：
Frontoni, Simona
影响因子：
7.7
作者：
Koivikko, ML;Salmela, PI;Huikuri, HV
通讯作者：
Huikuri, HV
影响因子：
8
作者：
Dungan, Kathleen M.;Binkley, Philip;Osei, Kwame
通讯作者：
Osei, Kwame