Wexler Deborah J, Cagliero Enrico
Massachusetts General Hospital Diabetes Center and Harvard Medical School, 55 Fruit Street, Boston, MA 02114, USA.
Curr Diabetes Rev. 2007 Nov;3(4):239-43. doi: 10.2174/1573399810703040239.
The epidemic of diabetes and results from several recent trials demonstrating the benefits of intensive glycemic control in the ICU setting have focused attention on inpatient glycemic control on general hospital wards, where over 25% of patients have diabetes. Current management of inpatient glycemia is haphazard, relying on corrective doses of insulin after hyperglycemia has occurred (the insulin "sliding scale"). Although data to guide evidence-based management of inpatient glycemia in non-critically ill patients are scant, the American College of Endocrinology and the American Diabetes Association have advocated more intensive therapy in the general inpatient setting, and the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) has followed suit, launching an initiative on inpatient glycemic control. Extrapolation from basic and clinical studies suggests that improved diabetes management in general medical settings is likely to be beneficial, though the appropriate intensity of glycemic control in non-ICU settings has yet to be determined. Independent of the acute impact of inpatient glycemia, inpatient diabetes management is also important because hospitalization offers an opportunity to optimize care upon discharge for patients with poorly controlled diabetes. Finally, systems-level strategies likely to improve inpatient diabetes management are reviewed.
糖尿病的流行以及近期多项试验表明在重症监护病房（ICU）环境中强化血糖控制的益处，使得人们将注意力集中在综合医院病房的住院患者血糖控制上，在这些病房中超过25%的患者患有糖尿病。目前住院患者血糖的管理很随意，依赖于高血糖发生后给予的胰岛素纠正剂量（胰岛素“滑动剂量表”）。尽管指导非重症患者住院血糖循证管理的数据很少，但美国内分泌学会和美国糖尿病协会主张在普通住院环境中采用更强化的治疗方法，医疗保健机构认证联合委员会（JCAHO）也采取了同样的做法，发起了一项住院患者血糖控制倡议。基础和临床研究的推断表明，在普通医疗环境中改善糖尿病管理可能是有益的，尽管非ICU环境中血糖控制的适当强度尚未确定。除了住院患者高血糖的急性影响外，住院糖尿病管理也很重要，因为住院为控制不佳的糖尿病患者出院后优化护理提供了机会。最后，对可能改善住院糖尿病管理的系统层面策略进行了综述。
