您当前的位置: > 详细浏览

持续皮下胰岛素注射治疗老年2型糖尿病效果的Meta分析与试验序贯分析

摘要:背景 胰岛素在糖尿病患者的治疗中起着重要作用,胰岛素可以进行每日多次注射(MDI),也可以通过胰岛素泵实现持续皮下胰岛素注射(CSII),目前对两种注射方法在老年2型糖尿病(T2DM)人群中的效果仍存在争议。目的 应用Meta分析方法评价CSII对老年T2DM患者的治疗效果,并用试验序贯分析(TSA)检验Meta分析结果的有效性。方法 计算机检索The Cochrane Library、PubMed、Embase、Medline、Scoups、Web of Science、中国知网、万方、维普和中国生物医学文献数据库从建库至2021年12月31日公开发表的关于CSII治疗老年T2DM的随机对照研究(RCTs)。两名研究者独立筛选文献、评价文献质量并提取资料。采用Review Manager 5.3软件对符合质量标准的文献进行Meta分析,使用哥本哈根临床试验中心研发的TSA v0.9完成试验序贯分析。结果 共纳入16篇RCTs。Meta分析结果显示,试验组在改善老年T2DM患者的空腹血糖(FPG)[MD=-0.82,95%CI(-1.09,-0.54),P<0.05]、餐后2h血糖(2hPG)[MD=-0.76,95%CI(-1.39,-0.14),P<0.05]、糖化血红蛋白(HbA1c)[SMD=-1.23,95%CI(-2.23,-0.23),P<0.05]、严重低血糖发生率[RD=-0.10,95%CI(-0.17,-0.03),P<0.05]、胰岛素日用量[MD=-9.63,95%CI(-12.35,-6.92),P<0.05]、平均血糖波动幅度(MAGE)[MD=-1.19,95%CI(-1.40,-0.97),P<0.05] 的效果优于对照组。对主要结局指标进行试验序贯分析,同样得到肯定的结论,即CSII治疗能明显降低老年T2DM患者的FPG、2hPG、HbA1水平和严重低血糖发生率。结论 相对于MDI, CSII能进一步改善老年T2DM患者的血糖控制水平、降低低血糖发生率和血糖波动幅度,同时也有一定的经济效益。本研究已在PROSPERO平台注册,注册号为CRD42021283729。

英文摘要:Background Insulin plays an important role in the treatment of diabetics and it can be administered either by multiple daily injections (MDI) or by continuous subcutaneous insulin infusion (CSII) via insulin pump. There is still controversy about the effectiveness of both injection methods among elderly adults with type 2 diabetes mellitus (T2DM). Objective Meta-analysis was used to evaluate the effectiveness of CSII among elderly adults with T2DM, and the validity of the results of the Meta-analysis was tested using trial sequential analysis (TSA). Methods The Cochrane Library, PubMed, Embase, Medline, Scoups, Web of Science, CNKI, Wanfang Database, CQVIP and CBM were retrieved by computer for the randomised controlled trials (RCTs) published from inception to 31 December 2021 regarding the application of CSII among elderly adults with T2DM. Two researchers independently screened the retrieved literature, evaluated the quality and extracted data. Meta-analysis of literature meeting quality standards was performed using Review Manager 5.3 software, and sequential analysis of trials was completed using TSA v0.9, developed by the Copenhagen Clinical Trial Centre. Results A total of 16 RCTs were included. The experimental group outperformed the control group in improving fasting plasma glucose (FPG) [MD=-0.82,95%CI(-1.09,-0.54),P<0.05]、2-hour postprandial blood glucose (2hPG)[MD=-0.76,95%CI(-1.39,-0.14),P<0.05]、glycosylated hemoglobin (HbA1c) [SMD=-1.23,95%CI(-2.23,-0.23),P<0.05]、incidence of severe hypoglycaemia [RD=-0.10,95%CI(-0.17,-0.03),P<0.05]、daily insulin dose [MD=-9.63,95%CI(-12.35,-6.92),P<0.05]、mean amplitude of glycemic excursions (MAGE) [MD=-1.19,95%CI(-1.40,-0.97),P<0.05]. A trial sequential analysis of the main outcome indicators likewise led to the same conclusion that CSII treatment significantly reduced FPG,2hPG,HbA1c levels and the incidence of severe hypoglycaemia among elderly adults with T2DM. Conclusion Compared to MDI, CSII can further improve glycaemic control, reduce the incidence of hypoglycaemia and the magnitude of glycaemic fluctuations among elderly patients with T2DM, and also has some economic benefits. This study has been registered on the PROSPERO under registration number CRD42021283729.

版本历史

[V1] 2022-08-12 18:31:10 chinaXiv:202208.00085V1 下载全文
点击下载全文
许可声明
metrics指标
  • 点击量1165
  • 下载量86
评论
分享
邀请专家评阅