Instructor in Medicine, Massachusetts General Hospital Diabetes Center & Harvard Medical School, Bulfinch 408, 55 Fruit Street, Boston, MA 02114, USA.
Expert Rev Pharmacoecon Outcomes Res. 2007 Oct;7(5):491-502. doi: 10.1586/14737167.7.5.491.
A quarter of patients who are hospitalized for any reason have diabetes as a comorbid condition. Despite this, management of diabetes among inpatients has historically been a low clinical priority. Since the publication of several landmark trials demonstrating the benefits of intensive glycemic control in the surgical intensive care unit, inpatient glycemic control on general hospital wards has received increased attention. Physicians and healthcare organizations in the USA have recently advocated more aggressive treatment of inpatient hyperglycemia despite the lack of data to guide evidence-based management in general (non-intensive care unit) settings. These calls to action have prompted a series of studies that demonstrate effective systems-based strategies for measuring and improving inpatient glycemic control, even though it is not yet clear how aggressively this goal should be pursued. While the data on improved long-term outcomes related to improved glycemic control in general inpatient settings are sparse, at the very least, inpatient diabetes management is likely to be beneficial if it prevents extremes of hyper- and hypoglycemia, decreases medication error, and facilitates improved outpatient medication regimens and self-management skills, which, in turn, may lead to improved glycemic control after discharge.
四分之一因任何原因住院的患者都伴有糖尿病。尽管如此，住院患者的糖尿病管理在临床上一直是次要的。自几项具有里程碑意义的试验表明强化血糖控制在外科重症监护病房中的益处以来，普通病房的住院患者血糖控制得到了更多的关注。尽管缺乏数据来指导一般（非重症监护病房）环境下基于证据的管理，但美国的医生和医疗保健组织最近主张更积极地治疗住院患者高血糖，尽管缺乏数据来指导一般（非重症监护病房）环境下基于证据的管理。这些行动呼吁促使了一系列研究，这些研究展示了测量和改善住院患者血糖控制的有效的基于系统的策略，即使目前尚不清楚应该多积极地追求这一目标。虽然与改善一般住院患者血糖控制相关的长期结果数据很少，但至少，如果住院患者的糖尿病管理能够预防高血糖和低血糖的极端情况，减少药物错误，促进改善门诊药物治疗方案和自我管理技能，这可能会导致出院后血糖控制得到改善。
