皮下胰岛素抵抗的循证治疗

    Evidence-Based Treatment of Subcutaneous Insulin Resistance in a Type 1 Diabetic Female

    • 摘要: 目的 采用循证医学方法为1例对皮下注射胰岛素抵抗、静脉输注胰岛素敏感的1型糖尿病患者制定治疗方案。 方法 根据临床问题检索ACP Journal Club、Cochrane图书馆、PubMed和CNKI数据库,获取并评价相关系统评价、原始文献及其质量与适用性。 结果 共获得有关皮下胰岛素抵抗诊断的文献综述1篇,有关静脉输注胰岛素、腹膜植入胰岛素泵、肌内注射胰岛素、持续皮下输注胰岛素类似物联合肝素、外用蛋白酶抑制剂、吸入胰岛素、胰岛细胞移植等治疗方法的原始文献15篇。所获证据表明: 仅用皮下注射胰岛素不能有效控制血糖,患者反复出现酮症,改变给药方式,采用上述治疗方案均可以降低血糖,提高临床疗效。有关胰岛素类似物是否奏效尚未见报道。结合客观证据、患者意愿、经济条件和医院技术条件,为患者实施了皮下注射胰岛素类似物联合口服葡萄糖苷酶抑制剂的治疗方案,经过15个月随访,证实治疗取得成功。 结论 循证医学方法有助于皮下胰岛素抵抗的早期诊断和合理治疗。

       

      Abstract: Objective To develop an evidence-based treatment plan for a type 1 diabetic female who was resistant to subcutaneous insulin injection but sensitive to intravenous insulin infusion. Methods Articles in ACP Journal Club,Cochrane library,PubMed and CNKI were searched according to the clinical question. The quality and applicability of systematic review and original literature were evaluated respectively. Results There was one article about the diagnosis of subcutaneous insulin resistance. Other five articles were related to the treatment,including intravenous insulin infusion, intraperitoneal insulin infusion, intramuscular insulin injection and continuous subcutaneous insulin infusion via an insulin pump, et al. Those articles indicated that ketosis reoccurred when only subcutaneous insulin was administered, but those special treatment mentioned above could manage hyperglycemia. There was no report whether the insulin analog could manage subcutaneous insulin resistance until now. So the treatment of subcutaneous insulin analog and oral glycosidase inhibitor was applied in the patient on the basis of assessing the objective evidence, the aspiration of the patient,the condition of economy and technology. The treatment turned out to be successful after 15 months follow-up visit. Conclusion The evidence-based medicine contributes to the early diagnosis and reasonable treatment of subcutaneous insulin resistance.

       

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