Efficacy and safety comparison of continuous subcutaneous insulin analogues infusion and multiple daily insulin analogues injection in fracture patients with type 2 diabetes mellitus during the perioperative period
10.3760/cma.j.cn114015-20220714-00636
- VernacularTitle:骨折合并2型糖尿病患者围术期胰岛素类似物持续皮下输注与每日多次皮下注射的疗效和安全性比较
- Author:
Wei LI
1
;
Quanzhi LI
;
Quan LI
;
Zhixin WANG
;
Xiaojie XU
;
Ru WANG
;
Wei DENG
Author Information
1. 北京积水潭医院内分泌科，北京 100035
- Publication Type:Journal Article
- Keywords:
Diabetes mellitus;
Fractures, bone;
Hypoglycemia;
Perioperative period;
Injections, subcutaneous;
Continuous subcutaneous insulin injection
- From:
Adverse Drug Reactions Journal
2022;24(11):578-583
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To compare the efficacy and safety of continuous subcutaneous insulin analogues infusion (CSII) and multiple daily insulin analogues injection (MDII) in fracture patients with type 2 diabetes mellitus (T2MD) during the perioperative period.Methods:The medical data of patients with lower limb fracture complicated with T2MD in Beijing Jishuitan Hospital from 2017 to 2021 were collected by hospital information system and analyzed retrospectively. The medical data of patients extracted included gender, age, body weight, body mass index (BMI), fracture site, pain score and grading, time from fracture to admission, duration of T2MD, laboratory test results at admission, blood glucose control regimen and monitoring result after admission, and the adverse events. Patients were divided into CSII group and MDII group according to blood glucose control regimen during the perioperative period. The clinical features, time to reach target blood glucose range, insulin application, and adverse events in patients of the 2 groups were compared.Results:A total of 207 patients were enrolled in this study, including 90 males and 117 females, aged (61±15) years with BMI of (25.5±3.5) kg/m 2. No significant differences were found in gender, age, BMI, fracture site, pain score and grading, time from fracture to admission, duration of T2MD, and laboratory test resurts at admission in patients between the 2 groups (all P>0.05). Patients in the CSII group had shorter time to reach target range of fasting blood glucose, 2-h postprandial blood glucose, and the both than those in the MDII group [(48.7±30.2) h vs. (78.7±44.5) h, P=0.003; (66.8±31.5) h vs. (93.3±47.6) h, P=0.001; (68.4±30.5) h vs. (96.3±48.1) h, P<0.001]. The total daily dose and total pre-prandial dose of insulin per unit weight in patients when the fasting and 2-h postprandial glucose both reach the target range were less in the CSII group than those in the MDII group [(0.67±0.20) U/kg vs. (0.73±0.17) U/kg, P=0.030; (0.34±0.10) U/kg vs. (0.38±0.09) U/kg, P=0.004]. In 207 patients, hypoglycemia occurred in 17 patients for 23 times with an overall incidence of 8.2%(17/207). The difference in the incidence of hypoglycemia was not significant between the 2 groups [4.9%(5/102) vs. 11.4%(12/105), P=0.319]. None of the 5 patients with hypoglycemia in the CSII group had hypoglycemia for 2 times or more, while 4 of the 12 patients in the MDII group had 2 times of hypoglycemia and 1 had 3 times of hypoglycemia. Other adverse drug events included allergy, systemic edema, nodular hyperplasia of subcutaneous fat, and persistent bleeding at the injection site. Eight patients in the CSII group had other adverse events, including device failure in 5 patients, and using insulin pump during anesthesia, in magnetic field environment, and in humid environment in 3 patients respectively. Conclusions:CSII regimen is helpful for fracture patients with T2DM to achieve target blood glucose range earlier, and provides more ways and opportunities to correct hypoglycemia in patients. However, the insulin pump needs more professional maintenance in practice, so it has limitations to some extent in clinical application.
