Braithwaite Susan Shapiro
Division of Endocrinology, University of North Carolina-Chapel Hill, Chapel Hill, North Carolina 27599-7172, USA.
Curr Opin Endocrinol Diabetes Obes. 2008 Apr;15(2):159-66. doi: 10.1097/MED.0b013e3282f827e7.
In a 2001 report from a surgical intensive care unit in Leuven, Belgium, intravenous insulin infusion targeting blood glucose 80-110 mg/dl reduced patient mortality and morbidities. Subsequent research has failed to define glycemic targets necessary or sufficient for attainment of desired health outcomes in other inpatient settings, but a large body of evidence suggests hospital outcomes are related to hyperglycemia.
Recent literature describes observational evidence for hypoglycemia as an independent predictor of mortality in a general medical intensive care unit; superiority of performance of computerized intravenous insulin algorithms in comparison to earlier manual algorithms; acceptability of early transition to scheduled basal prandial correction subcutaneous insulin analog therapy for maintenance of glycemic targets after induction of euglycemia by intravenous insulin infusion, among cardiothoracic surgery patients; inferiority of sliding scale insulin compared to basal prandial correction therapy; and feasibility of diabetes patient self-management in the hospital setting.
With development of improved insulin administration strategies problems of hypoglycemia and variability of glycemic control are reduced. Investigators and care providers need to achieve glycemic targets to optimize patient outcomes.
2001年比利时鲁汶一家外科重症监护病房的报告显示，将血糖目标控制在80 - 110 mg/dl的静脉胰岛素输注可降低患者死亡率和发病率。后续研究未能明确在其他住院环境中实现理想健康结局所需或足够的血糖目标，但大量证据表明医院结局与高血糖有关。
近期文献描述了在普通内科重症监护病房中，低血糖作为死亡率独立预测因素的观察性证据；与早期手动算法相比，计算机化静脉胰岛素算法的优越性；在心胸外科患者中，静脉胰岛素输注诱导血糖正常后，早期过渡到预定的基础餐时校正皮下胰岛素类似物治疗以维持血糖目标的可接受性；与基础餐时校正治疗相比，胰岛素滑动剂量疗法的劣势；以及糖尿病患者在医院环境中自我管理的可行性。
随着胰岛素给药策略的改进，低血糖问题和血糖控制的变异性得以减少。研究人员和护理人员需要实现血糖目标以优化患者结局。
