Mayo Clinic College of Medicine, Scottsdale, Arizona, USA.
J Hosp Med. 2009 Nov;4(9):E7-E14. doi: 10.1002/jhm.533.
Despite increased awareness of the value of treating inpatient hyperglycemia, little is known about glucose control in U.S. hospitals.
The Remote Automated Laboratory System-Plus (RALS-Plus Medical Automation Systems, Charlottesville, VA) was used to extract inpatient point-of-care bedside glucose (POC-BG) tests from 126 hospitals for the period January to December 2007. Patient-day-weighted mean POC-BG and hypoglycemia/hyperglycemia rates were calculated for intensive care unit (ICU) and non-ICU areas. The relationship of POC-BG levels with hospital characteristics was determined.
A total of 12,559,305 POC-BG measurements were analyzed: 2,935,167 from the ICU and 9,624,138 from the non-ICU. Patient-day-weighted mean POC-BG was 165 mg/dL for ICU and 166 mg/dL for non-ICU. Hospital hyperglycemia (>180 mg/dL) prevalence was 46.0% for ICU and 31.7% for non-ICU. Hospital hypoglycemia (<70 mg/dL) prevalence was low at 10.1% for ICU and 3.5% for non-ICU. For ICU and non-ICU there was a significant relationship between number of beds and patient-day-weighted mean POC-BG levels, with larger hospitals (> or = 400 beds) having lower patient-day weighted mean POC-BG per patient day than smaller hospitals (<200 beds, P < 0.001). Rural hospitals had higher POC-BG levels compared to urban and academic hospitals (P < 0.05), and hospitals in the West had the lowest values.
POC-BG data captured through automated data management software can support hospital efforts to monitor the status of inpatient glycemic control. From these data, hospital hyperglycemia is common, hypoglycemia prevalence is low, and POC-BG levels vary by hospital characteristics. Increased hospital participation in data collection and reporting may facilitate the creation of a national benchmarking process for the development of best practices and improved inpatient hyperglycemia management.
尽管人们越来越意识到治疗住院患者高血糖的价值，但对于美国医院的血糖控制情况却知之甚少。
使用 Remote Automated Laboratory System-Plus（RALS-Plus Medical Automation Systems，弗吉尼亚州夏洛茨维尔）从 2007 年 1 月至 12 月期间的 126 家医院中提取了住院患者床边即时血糖（POC-BG）检测数据。计算了重症监护病房（ICU）和非 ICU 区域的患者日加权平均 POC-BG 和低血糖/高血糖发生率。确定了 POC-BG 水平与医院特征之间的关系。
共分析了 12559305 次 POC-BG 测量值：ICU 为 2935167 次，非 ICU 为 9624138 次。患者日加权平均 POC-BG 为 ICU 患者 165mg/dL，非 ICU 患者 166mg/dL。ICU 医院高血糖（>180mg/dL）患病率为 46.0%，非 ICU 为 31.7%。ICU 医院低血糖（<70mg/dL）患病率较低，为 10.1%，非 ICU 为 3.5%。对于 ICU 和非 ICU，床位数与患者日加权平均 POC-BG 水平之间存在显著关系，床位数较大（>或=400 床）的医院每位患者每天的患者日加权平均 POC-BG 低于床位数较小（<200 床，P<0.001）的医院。与城市和学术医院相比，农村医院的 POC-BG 水平更高（P<0.05），而西部医院的 POC-BG 水平最低。
通过自动化数据管理软件捕获的 POC-BG 数据可以支持医院监测住院患者血糖控制状况的工作。根据这些数据，医院高血糖症很常见，低血糖症患病率较低，POC-BG 水平因医院特征而异。增加医院对数据收集和报告的参与可能有助于创建一个全国性的基准流程，以制定最佳实践并改善住院患者高血糖症管理。
