Abstract：
OBJECTIVE: The standard of care for burned patients experiencing hyperglycemia associated with the hypermetabolic response is insulin therapy. Insulin treatment predisposes burn patients to hypoglycemia, which increases morbidity and mortality. Metformin has been suggested as an alternative to insulin therapy for glycemic control in burn patients given its safety profile, but further research is warranted. This study investigated whether metformin use in burn patients is associated with improved glycemic control and morbidity/mortality outcomes compared to insulin use alone.
METHODS: Using the TriNetX database, we conducted a retrospective study of burned patients who were administered insulin, metformin, or both within one week of injury. Demographic, comorbidity, and burn severity information were collected. Patients were categorized by treatment type, propensity score-matched, and compared for the following outcomes within 3 months: hyperglycemia, hypoglycemia, sepsis, lactic acidosis, and death. Statistical significance was set a priori at p ≤ 0.05.
RESULTS: The insulin cohort was at increased risk for all outcomes (all p < 0.0001) compared to the metformin cohort, and an increased risk for sepsis, lactic acidosis, and death (all p ≤ 0.0002) compared to the insulin/metformin combination cohort. When compared to the metformin cohort, the combination cohort was at increased risk for all outcomes (all p ≤ 0.0107) except death.
CONCLUSIONS: Treatment with metformin after burn is associated with a reduced risk of morbidity and mortality compared to insulin. The combination of insulin and metformin is no more effective in reducing the risk of hyperglycemia and hypoglycemia than insulin alone but is less effective than metformin alone.
METHODS: Using the TriNetX database, we conducted a retrospective study of burned patients who were administered insulin, metformin, or both within one week of injury. Demographic, comorbidity, and burn severity information were collected. Patients were categorized by treatment type, propensity score-matched, and compared for the following outcomes within 3 months: hyperglycemia, hypoglycemia, sepsis, lactic acidosis, and death. Statistical significance was set a priori at p ≤ 0.05.
RESULTS: The insulin cohort was at increased risk for all outcomes (all p < 0.0001) compared to the metformin cohort, and an increased risk for sepsis, lactic acidosis, and death (all p ≤ 0.0002) compared to the insulin/metformin combination cohort. When compared to the metformin cohort, the combination cohort was at increased risk for all outcomes (all p ≤ 0.0107) except death.
CONCLUSIONS: Treatment with metformin after burn is associated with a reduced risk of morbidity and mortality compared to insulin. The combination of insulin and metformin is no more effective in reducing the risk of hyperglycemia and hypoglycemia than insulin alone but is less effective than metformin alone.
摘要：
目的：患有与高代谢反应相关的高血糖的烧伤患者的标准治疗是胰岛素治疗。胰岛素治疗使烧伤患者容易发生低血糖，这增加了发病率和死亡率。鉴于二甲双胍的安全性，已被建议作为胰岛素治疗的替代药物来控制烧伤患者的血糖。但需要进一步的研究。这项研究调查了与单独使用胰岛素相比，烧伤患者使用二甲双胍是否与改善血糖控制和发病率/死亡率相关。
方法：使用TriNetX数据库，我们对接受胰岛素治疗的烧伤患者进行了回顾性研究，二甲双胍,或者两者都在受伤后一周内。人口统计,合并症，并收集烧伤严重程度信息。患者按治疗类型分类，倾向得分匹配，并比较3个月内的以下结果：高血糖，低血糖,脓毒症,乳酸性酸中毒,和死亡。统计显著性先验地设定为p≤0.05。
结果：与二甲双胍组相比，胰岛素组所有结局的风险均增加（所有p<0.0001），败血症的风险增加，乳酸性酸中毒,与胰岛素/二甲双胍联合队列相比，死亡（均p≤0.0002）。与二甲双胍队列相比，除死亡外,组合队列在所有结局(所有p≤0.0107)中的风险均增加.
结论：与胰岛素相比，烧伤后二甲双胍治疗可降低发病率和死亡率。胰岛素和二甲双胍的组合在降低高血糖和低血糖风险方面没有单独使用胰岛素更有效,但不如单独使用二甲双胍有效。
方法：使用TriNetX数据库，我们对接受胰岛素治疗的烧伤患者进行了回顾性研究，二甲双胍,或者两者都在受伤后一周内。人口统计,合并症，并收集烧伤严重程度信息。患者按治疗类型分类，倾向得分匹配，并比较3个月内的以下结果：高血糖，低血糖,脓毒症,乳酸性酸中毒,和死亡。统计显著性先验地设定为p≤0.05。
结果：与二甲双胍组相比，胰岛素组所有结局的风险均增加（所有p<0.0001），败血症的风险增加，乳酸性酸中毒,与胰岛素/二甲双胍联合队列相比，死亡（均p≤0.0002）。与二甲双胍队列相比，除死亡外,组合队列在所有结局(所有p≤0.0107)中的风险均增加.
结论：与胰岛素相比，烧伤后二甲双胍治疗可降低发病率和死亡率。胰岛素和二甲双胍的组合在降低高血糖和低血糖风险方面没有单独使用胰岛素更有效,但不如单独使用二甲双胍有效。
