Pharmacy Department, Medical Center of Plano, Plano, TX, USA.
Ann Pharmacother. 2009 Nov;43(11):1774-80. doi: 10.1345/aph.1M331. Epub 2009 Oct 13.
Development of hyperglycemia during hospitalization is an area of concern in patients with and without diabetes mellitus. Tight glycemic control has been debated for critically ill and noncritically ill patients with hyperglycemia. Although many studies have been performed in the critically ill, adequate data are not available in the noncritically ill population.
To compare traditional sliding scale (SS) with a tight glycemic control (TC) algorithm. The primary endpoint was the percentage of total blood glucose measurements in the target range of 80-150 mg/dL. The secondary endpoint evaluated was safety, defined as percentage of all blood glucose measurements that were 0-60 mg/dL.
A 1-year, retrospective analysis from June 1, 2007, to May 31, 2008, was performed evaluating all inpatients with hyperglycemia within the first 48 hours of admission to the Medical Center of Plano, Plano, TX. A cohort of patients managed with SS (n =121) was compared with those treated with TC (n = 210). Patients on SS insulin received a traditional SS regimen with regular insulin or insulin aspart based on physician preference.
Demographics and comorbidities were similar between the 2 groups; however, the TC cohort was younger (64.8 + or - 14.1 vs 70.8 + or - 13.7 y; p < 0.001). There were more persons with type 2 diabetes mellitus in the TC cohort (81.9%) versus the SS cohort (60.3%; p < 0.001). In the TC cohort, 42.9% of blood glucose measurements were in the target range of 80-150 mg/dL compared with 30.6% of the measurements in the SS cohort (p < 0.001). Regarding safety, 2% of blood glucose measurements of the TC cohort were in the range of 0-60 mg/dL versus 0.3% of the SS cohort (p < 0.001). No clinical sequelae of hypoglycemia were observed. Patients achieved more blood glucose measurements in the target range when treated with TC versus SS insulin, without regard to prior history of diabetes.
Patients treated with TC experienced more blood glucose measurements in the target range as compared with patients treated with SS with relatively low hypoglycemia rates.
住院期间高血糖的发生是糖尿病患者和非糖尿病患者关注的领域。对于危重症和非危重症高血糖患者，强化血糖控制一直存在争议。虽然已经在危重症患者中进行了许多研究，但非危重症人群中没有足够的数据。
比较传统的滑动量表（SS）与严格血糖控制（TC）算法。主要终点是目标范围内（80-150mg/dL）的总血糖测量百分比。次要终点评估为安全性，定义为所有血糖测量值在 0-60mg/dL 的百分比。
对 2007 年 6 月 1 日至 2008 年 5 月 31 日期间在得克萨斯州普莱诺医疗中心住院的所有入院后 48 小时内发生高血糖的住院患者进行了为期 1 年的回顾性分析。将接受 SS 治疗的患者（n=121）与接受 TC 治疗的患者（n=210）进行比较。接受 SS 胰岛素治疗的患者接受了基于医生偏好的常规胰岛素或门冬胰岛素的传统 SS 方案。
两组患者的人口统计学和合并症相似；然而，TC 组更年轻（64.8+/-14.1 vs 70.8+/-13.7y；p<0.001）。TC 组中患有 2 型糖尿病的人数（81.9%）多于 SS 组（60.3%；p<0.001）。在 TC 组中，42.9%的血糖测量值处于 80-150mg/dL 的目标范围内，而 SS 组的这一比例为 30.6%（p<0.001）。在安全性方面，TC 组的 2%血糖测量值处于 0-60mg/dL 范围内，而 SS 组为 0.3%（p<0.001）。没有观察到低血糖的临床后果。与接受 SS 胰岛素治疗的患者相比，接受 TC 治疗的患者血糖测量值达到目标范围的次数更多，无论其糖尿病既往史如何。
与接受 SS 治疗的患者相比，接受 TC 治疗的患者血糖测量值达到目标范围的次数更多，且低血糖发生率相对较低。
