Prandial insulin dosing using the carbohydrate counting technique in hospitalized patients with type 2 diabetes.
Prandial insulin dosing using the carbohydrate counting technique in hospitalized patients with type 2 diabetes.
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DOI：
10.2337/dc13-0121
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发表时间：
2013-11
期刊：
影响因子：
16.2
通讯作者：
Osei K
中科院分区：
文献类型：
--
作者：
Dungan KM;Sagrilla C;Abdel-Rasoul M;Osei K
在2型糖尿病住院患者中比较改良固定餐给药策略与灵活餐给药策略。将患有难治性高血糖症或每天需要至少20个单位胰岛素的患者（N = 126）随机分配至固定餐时给药组（包括如果进食量少于餐盘的一半，则暂停给药）或基于碳水化合物摄入量的灵活餐时给药组。住院糖尿病管理团队进行了所有治疗调整。结果包括第3天平均血糖、72小时血糖趋势分析、低血糖（<3.9 mmol/L）和住院糖尿病治疗满意度。固定餐组和灵活餐组第3天的平均血糖分别为9.5和8.8 mmol/L（P = 0.26）。固定餐组和灵活餐组的低血糖发生率分别为23%和39%（P = 0.08），其中一半事件发生在早晨。碳水化合物摄入量的范围很广（第3天的中位数为51 g/餐，10 - 90%范围为26 - 72 g）。固定剂量组总体上需要显著更多的餐时胰岛素，并且随着时间的推移需要更多的校正胰岛素。两组间的复合治疗满意度或剂量计算错误无差异。当由住院糖尿病治疗团队管理时，固定膳食给药策略提供了与灵活膳食给药相似的血糖控制。然而，需要更大的样本量来明确评估医院灵活膳食给药的治疗效果。需要进一步研究以改善住院患者的餐时胰岛素输注。
To compare a modified fixed meal dosing strategy to flexible meal dosing in hospitalized patients with type 2 diabetes. Patients (N = 126) with refractory hyperglycemia or requiring at least 20 units of insulin per day were randomly assigned to fixed meal dosing (including withholding the dose if less than half of the meal tray was consumed) or flexible meal dosing based upon carbohydrate intake. The inpatient diabetes management team made all treatment adjustments. Outcomes included day 3 mean glucose, 72-h glucose trend analysis, hypoglycemia (<3.9 mmol/L), and inpatient diabetes treatment satisfaction. The mean glucose on day 3 was 9.5 and 8.8 mmol/L in the fixed and flexible meal groups, respectively (P = 0.26). The frequency of hypoglycemia was 23 and 39% overall in the fixed and flexible meal groups (P = 0.08), with half of events occurring in the morning. There was a wide range of carbohydrate intake (median 51 g/meal, 10–90% range 26–72 g on day 3). The fixed dose group required significantly more prandial insulin overall and more correction insulin over time. There was no difference in composite treatment satisfaction or dosing miscalculations between groups. A fixed meal dosing strategy provided similar glucose control as flexible meal dosing, when managed by an inpatient diabetes treatment team. However, a larger sample size would be needed to definitively evaluate a treatment effect of flexible meal dosing in the hospital. Further study is needed to improve the delivery of bolus insulin in hospitalized patients.