生玉米淀粉改善胰岛素瘤相关低血糖的疗效：一种有前景的支持治疗

doi:10.24920/004329

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To provide evidence to validate the efficacy and safety of raw corn starch in improving insulinoma-associated hypoglycemia, the authors from Peking Union Medical College Hospital retrospectively analyzed the therapeutic effects of raw corn starch intervention preoperatively on blood glucose control, weight change, and adverse events in insulinoma patients, and they concluded that the RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia.

Abstract

Objective To investigate the efficacy of raw corn starch (RCS) in clinical management of insulinoma-induced hypoglycemia.
Methods We retrospectively collected clinical data of insulinoma patients who received RCS-supplemented diet preoperatively, and analyzed the therapeutic effects of the RCS intervention on blood glucose control, weight change, and its adverse events.
Results The study population consisted of 24 cases of insulinoma patients, 7 males and 17 females, aged 46.08±14.15 years. Before RCS-supplemented diet, all patients had frequent hypoglycemic episodes (2.51±3.88 times/week), concurrent with neuroglycopenia (in 83.3% of patients) and autonomic manifestations (in 75.0% of patients), with the median fasting blood glucose (FBG) of 2.70 (interquartile range [IQR]: 2.50-2.90) mmol/L. The patients' weight increased by 0.38 (IQR: 0.05-0.65) kg per month, with 8 (33.3%) cases developing overweight and 7 (29.2%) cases developing obesity. All patients maintained the RCS-supplemented diet until they underwent tumor resection (23 cases) and transarterial chemoembolization for liver metastases (1 case). For 19 patients receiving RCS throughout the day, the median FBG within one week of nutritional management was 4.30 (IQR: 3.30-5.70) mmol/L, which was a significant increase compared to pre-nutritional level [2.25 (IQR: 1.60-2.90) mmol/L; P < 0.001]. Of them, 10 patients receiving RCS throughout the day for over four weeks had sustained improvement in FBG compared to pre-treatment [3.20 (IQR: 2.60-3.95) mmol/L vs. 2.15 (IQR: 1.83-2.33) mmol/L; P < 0.001). Five patients who received RCS only at night also had a significant increase in FBG within one week of nutritional management [3.50 (IQR: 2.50-3.65) mmol/L vs. 2.20 (IQR:1.80-2.60) mmol/L; P < 0.001], but only one patient who continued to receive RCS for over four weeks did not have a significant improvement in FBG. No improvement in weight gain was observed upon RCS supplementation. Mild diarrhea (2 cases) and flatulence (1 case) occurred, and were relieved by reduction of RCS dose.
Conclusion The RCS-supplemented diet is effective in controlling insulinoma-induced hypoglycemia.

Key words: corn starch, hypoglycemia, insulinoma, nutrition therapy

Rong-Rong Li, Wei Chen, Xin-Hua Xiao, Miao Yu, Fan Ping, Lian Duan. Efficacy of Raw Corn Starch in Insulinoma-Related Hypoglycemia: A Promising Supportive Therapy[J].Chinese Medical Sciences Journal, 2024, 39(2): 102-110.

Figures/Tables 3

Table 1.

Demographic and clinical characteristics of 24 included insulinoma patients with preoperative RCS intervention"

No.	Sex	Age (yrs)	Number of tumor	Insulinoma	Main management	BMI on admission (kg/m²)	RCS			FBG (median, mmol/L)
No.	Sex	Age (yrs)	Number of tumor	Insulinoma	Main management	BMI on admission (kg/m²)	Consumpiton (g/time)	Frequency	Duration (d)	Before nutritional intervention	Within the 1st week on nutritional intervention	After 4 weeks on nutritional intervention
1	F	55	Solitary	Benign	Surgical excision	23.21	No specific amount recorded	Every 6 hours through a day	3	3.1	5.3	-
2	F	61	Solitary	Benign	Surgical excision	34.24	50.00	Every 6 hours through a day	4	2.9	5.7	-
3	F	51	Solitary	Benign	Surgical excision	31.63	No specific amount recorded	Every 6 hours through a day	6	1.4	2.3	-
4	F	49	Solitary	Malignant, with liver metastases	Surgical excision	30.39	100.00	Once at bedtime	10	2.5	5.2	-
5	F	40	Solitary	Benign	Surgical excision	29.94	75.00	Every 6 hours through a day	11	1.6	3.3	-
6	F	52	Solitary	Benign	Surgical excision	34.63	No specific amount recorded	Every 6 hours through a day	14	1.6	5.7	-
7	F	44	Solitary	Benign	Surgical excision	25.10	No specific amount recorded	Every 6 hours through a day	16	2.0	5.4	-
8	F	63	Solitary	Benign	Surgical excision	29.21	50.00	Every 6 hours through a day	18	2.4	3.1	-
9	M	25	Solitary	Benign	Surgical excision	26.04	No specific amount recorded	Every 6 hours through a day	22	1.9	3.3	-
10	F	57	Solitary	Benign	Surgical excision	17.06	No specific amount recorded	Every 4 hours overnight (10 pm, 2-3 am)	22	2.6	4.7	-
11	F	72	Solitary	Benign	Surgical excision	21.71	No specific amount recorded	Every 6 hours through a day	23	2.8	4.5	-
12	F	50	Solitary	Benign	Surgical excision	19.96	50.00	Once at bedtime	27	2.6	3.5	-
13	F	30	Solitary	Benign	Surgical excision	24.94	25.00	Once at bedtime	28	1.9	3.7	-
14	M	34	Solitary	Benign	Surgical excision	24.92	No specific amount recorded	Every 6 hours through a day	31	2.9	2.0	4.2
15	M	30	Solitary	Malignant, with liver metastases	Hepatic transarterial chemoembolization of metastatic lesion	23.65	No specific amount recorded	Every 6 hours through a day	33	2.1	3.8	3.2
16	F	62	Solitary	Benign	Surgical excision	23.11	No specific amount recorded	Every 6 hours through a day	44	2.2	3.6	5.3
17	M	47	Solitary	Benign	Surgical excision	35.43	50.00	Once at bedtime	46	1.8	2.5	1.7
18	F	21	Solitary	Benign	Surgical excision	27.86	60.00	Every 6 hours through a day	47	1.6	3.4	2.6
19	M	42	Solitary	Benign	Surgical excision	31.89	50.00	Every 6 hours through a day	48	2.2	2.3	3.1
20	M	26	Solitary	Benign	Surgical excision	28.08	No specific amount recorded	Every 6 hours through a day	53	2.3	3.6	3.0
21	M	31	Multifocal	Benign	Surgical excision	26.81	No specific amount recorded	Every 6 hours through a day	68	1.6	4.4	3.8
22	F	61	Solitary	Benign	Surgical excision	28.78	75.00	Every 6 hours through a day	82	2.4	3.0	4.1
23	F	61	Solitary	Benign	Surgical excision	Not recorded	No specific amount recorded	Every 6 hours through a day	147	2.1	3.1	4.4
24	F	42	Solitary	Benign	Surgical excision	47.07	50.00	Every 6 hours through a day	192	1.9	3.5	3.3

Table 1.

Table 2.

Figure 1.

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Items	Before RCS diet	After RCS diet	P value
Neuroglycopenic symptoms [n (%)]	20 (83.33)	3 (12.50)	0.000
Confusion [n (%)]	12 (50.00)	3 (12.50)	0.011
Coma [n (%)]	14 (58.33)	0	0.000
Behavioral change [n (%)]	8 (33.33)	0	0.004
Seizure [n (%)]	3 (12.50)	0	0.234
Autonomic symptoms [n (%)]	18 (75.00)	15 (62.50)	0.534
Diaphoresis [n (%)]	15 (62.50)	10 (41.67)	0.248
Fatigue [n (%)]	13 (54.17)	8 (33.33)	0.244
Palpitation [n (%)]	10 (41.67)	7 (29.17)	0.547
Hyperphagia [n (%)]	7 (29.17)	5 (20.83)	0.740
Frequency of hypoglycemic onsets (times/week, mean ± SD)	2.51 ± 3.88	1.80 ± 0.84	0.893

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