Long-acting Insulin Analog Is A Good Choice For Blood Glucose Management During Peri-operation: Meta-analysis And Systematic Review

Aims: Hyperglycemic patients are at increased risk of postoperativecomplications. It is particularly important to control perioperative bloodglucose levels. However, there is limited evidence concerning the bestregime in perioperative glycemic control. The aim of the study was toindicate the potential benefit of long-acting insulin analogs (LAIA)compared with continuous subcutaneous insulin infusion (CSII), multipledaily injections (MDI), and sliding-scale insulin (SSI) in perioperativeglycemic control.Methods: Trials were obtained from searches of the Cochrane Library,MEDLINE, EMBASE, Pubmed, and the Chinese Science Citation Database.Only randomized controlled clinical trials were included. Compared the fourregimes of postoperative fasting plasma glucose (PFPG), postoperative2-hpostprandial blood glucose (P2-hPG), perioperative mean blood glucose(PMBG), insulin dosage, average hospitalization time, hypoglycemicepisode and postoperative complication by a meta-analyse and systematic review.Results: Sixteen randomized clinical trials were included.1) There wasno significant difference between LAIA group and CSII group in theP2-hPG (MD,0.16; p=0.15) and PMBG (MD,0.47; p=0.22); Comparedwith CSII group，LAIA group had higher PFPG levels (MD,0.20; p=0.001)and longer average hospitalization times (MD,3.75; p=0.04) but used alower insulin dosage (MD,-0.62; p=0.04).2) Compared with MDI group,LAIA group had significantly lower PFPG (MD,-0.86; p=0.001) andPMBG levels (MD,-0.40; p=0.04) and shorter average hospitalization times(MD,-3.17; p=0.03), but there was no difference in P2-hPG levels (MD,-1.09; p=0.09) and insulin dosage (MD,1.03; p=0.77).3) Compared withSSI group, LAIA group had significantly lower PFPG (MD,-0.60; p=0.04)and PMBG (MD,-0.97; p=0.007), but there was no difference in theperioperative insulin dosage (MD,7.08; p=0.17) or average hospitalizationtime (MD,0.17; p=0.64).4) Patients who were treated with LAIA group hadfewer hypoglycemic episodes than MDI group, and similar hypoglycemicepisodes as CSII group or SSI group. Compared with MDI group and SSIgroup, patients treated with LAIA group had a significantly lower incidenceof postoperative complications.Conclusion: For glycemic control effectively in the perioperativeperiod, LAIA are similar to CSII but better than SSI and MDI regimens;LAIA also had fewer hypoglycemic episodes than MDI, and a significantly lower incidence of postoperative complications than MDI or SSI. Therefore,LAIA can be a good choice for perioperative glucose management.