背景:胰高血糖素样肽1(GLP-1)和葡萄糖依赖性促胰岛素分泌肽(GIP)是肠促胰岛素激素。通过以葡萄糖依赖性方式降低血糖,基于肠促胰岛素的疗法代表了一种新颖且有前景的干预措施,可在医院环境中治疗高血糖症。我们对基于肠促胰岛素的治疗在围手术期和重症监护环境中的所有当前应用的文献进行了系统回顾。
方法:我们搜索了MEDLINE,Cochrane图书馆,和使用外源性GLP-1、GLP-1受体激动剂的所有随机对照试验的Embase数据库,成人围手术期护理或重症监护中的外源性GIP和二肽基肽酶IV抑制剂。我们没有定义比较治疗。感兴趣的结果包括血糖,低血糖和胰岛素给药的频率。
结果:在最初的文献检索中确定的1190篇文章中,38符合全文审查标准,19项单中心研究随后被纳入定性审查.在18项报告血糖控制的研究中,15例报告改善,12例定义为葡萄糖浓度降低,3例定义为胰岛素给药减少(葡萄糖浓度相似).由于异质性,荟萃分析仅适用于低血糖的结局。这表明接受肠促胰岛素治疗的患者的发病率为7.4%,对照组为6.8%(P=0.94)。
结论:在小,单中心研究,基于肠促胰岛素的治疗可降低血糖,减少胰岛素给药,但不增加低血糖的发生率。
背景:PROSPERO,CRD42017071926.
BACKGROUND: Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) are incretin hormones. By lowering blood glucose in a glucose-dependent manner, incretin-based therapies represent a novel and promising intervention to treat hyperglycaemia in hospital settings. We performed a systematic
review of the literature for all current applications of incretin-based therapies in the peri-operative and critical care settings.
METHODS: We searched MEDLINE, the Cochrane Library, and Embase databases for all randomised controlled trials using exogenous GLP-1, GLP-1 receptor agonists, exogenous GIP and dipeptidyl peptidase IV inhibitors in the setting of adult peri-operative care or intensive care. We defined no comparator treatment. Outcomes of interest included blood glucose, frequency of hypoglycaemia and insulin administration.
RESULTS: Of the 1190 articles identified during the initial literature search, 38 fulfilled criteria for full-text
review, and 19 single-centre studies were subsequently included in the qualitative
review. Of the 18 studies reporting glycaemic control, improvement was reported in 15, defined as lower glucose concentrations in 12 and as reduced insulin administration (with similar glucose concentrations) in 3. Owing to heterogeneity, meta-analysis was possible only for the outcome of hypoglycaemia. This revealed an incidence of 7.4% in those receiving incretin-based therapies and 6.8% in comparator groups (P = 0.94).
CONCLUSIONS: In small, single-centre studies, incretin-based therapies lowered blood glucose and reduced insulin administration without increasing the incidence of hypoglycaemia.
BACKGROUND: PROSPERO, CRD42017071926.