Schnipper Jeffrey L, Barsky Emily E, Shaykevich Shimon, Fitzmaurice Garrett, Pendergrass Merri L
Brigham and Women's/Faulkner Hospitalist Program, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts 02120-1613, USA.
J Hosp Med. 2006 May;1(3):145-50. doi: 10.1002/jhm.96.
Because of the relationship between inpatient hyperglycemia and adverse patient outcomes, current guidelines recommend glucose levels less than 180 mg/dL in the non-ICU inpatient setting and the use of effective insulin protocols for appropriate patients.
To determine the current state of glucose management on an academic hospitalist service and the relationship between insulin-ordering practices and glycemic control.
Prospective cohort study.
Hospitalist-run general medicine service of an academic teaching hospital.
107 consecutive patients with diabetes mellitus or inpatient hyperglycemia.
We collected data on up to 4 bedside glucose measurements per day, detailed clinical information, and all orders related to glucose management. The primary outcomes were rate of hyperglycemia (glucose > 180 mg/dL) per patient and mean glucose level per patient-day.
The mean rate of hyperglycemia was 31% of measurements per patient. Basal insulin was ordered for 43% of patients, and scheduled rapid- or short-acting insulin was ordered for 4% of patients. Sixty-five percent of patients who had at least 1 episode of hyper- or hypoglycemia had no change made to any insulin order during the first 5 days of the hospitalization. When adjusted for clinical factors, the use of sliding-scale insulin by itself was associated with a 20 mg/dL higher mean glucose level per patient-day.
Management of diabetes and hyperglycemia on a general medicine service showed several deficiencies in process and outcome. Possible targets for improvement include increased use of basal and nutritional insulin and daily insulin adjustment in response to hyperglycemia.
由于住院患者高血糖与不良患者结局之间的关系，当前指南建议在非重症监护病房（ICU）住院患者中，血糖水平应低于180 mg/dL，并对合适的患者使用有效的胰岛素方案。
确定学术性医院医师服务中血糖管理的现状以及胰岛素处方实践与血糖控制之间的关系。
前瞻性队列研究。
一所学术教学医院的医院医师管理的普通内科服务科室。
107例连续的糖尿病或住院患者高血糖患者。
我们每天收集多达4次床边血糖测量数据、详细的临床信息以及所有与血糖管理相关的医嘱。主要结局是每位患者的高血糖发生率（血糖>180 mg/dL）和每位患者每天的平均血糖水平。
每位患者的高血糖平均发生率为测量次数的31%。43%的患者接受了基础胰岛素治疗，4%的患者接受了预定的速效或短效胰岛素治疗。在住院的前5天，65%至少有1次高血糖或低血糖发作的患者，其胰岛素医嘱没有任何变化。在对临床因素进行调整后，单独使用滑动比例胰岛素与每位患者每天的平均血糖水平高出20 mg/dL相关。
普通内科服务中糖尿病和高血糖的管理在过程和结局方面存在若干不足。可能的改进目标包括增加基础胰岛素和营养胰岛素的使用，以及针对高血糖进行每日胰岛素调整。
