Department of Medicine, University of California, Los Angeles, CA, USA.
Am J Health Syst Pharm. 2010 Aug;67(16 Suppl 8):S3-8. doi: 10.2146/ajhp100171.
To review the risks of hyperglycemia in hospitalized patients, data supporting the benefits of treating hyperglycemia, and recommendations from the 2009 American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on the management of inpatient hyperglycemia.
Inpatient hyperglycemia is common, costly, and associated with poor clinical outcomes in many disease states. Despite inconsistencies in clinical trial results, good glucose management in the hospital remains important. Target blood glucose concentrations (BGs) were recently modified to somewhat higher values with the expectation that the benefit of treatment will persist with a lower risk of hypoglycemia, which is itself another marker of poor outcome in critically and non-critically ill patients. In the intensive care unit (ICU), the threshold to start treatment is a BG of <or=180 mg/dL. I.V. insulin is the treatment of choice in critically ill patients because of its rapid onset and offset of action. Once i.v. insulin is started, the BG should be maintained between 140 and 180 mg/ dL; a lower BG target (110-140 mg/dL) may be appropriate in selected patients. Targets of <110 mg/dL or >180 mg/dL are no longer recommended. In non-critically ill patients, premeal BG targets are <140 mg/dL; random BGs of <180 mg/dL are recommended. Scheduled subcutaneous insulin is the treatment of choice for hyperglycemia in non-critically ill patients; use of sliding-scale insulin is strongly discouraged. To avoid hypoglycemia, insulin regimens should be reassessed if BG falls to <100 mg/dL.
Poor glycemic control in the hospital setting is a quality-of-care, safety, and cost issue. Safe and effective strategies to implement optimal glycemic control require multidisciplinary involvement. Insulin given i.v. in the ICU or subcutaneously on an as-scheduled regimen in other parts of the hospital is the treatment of choice.
回顾住院患者高血糖的风险、支持治疗高血糖益处的数据以及 2009 年美国临床内分泌医师协会和美国糖尿病协会关于住院患者高血糖管理的共识声明中的建议。
住院患者高血糖很常见，费用高，并且与许多疾病状态下的不良临床结局相关。尽管临床试验结果存在不一致，但在医院中进行良好的血糖管理仍然很重要。目标血糖浓度（BG）最近被修改为稍高的值，预计在低血糖风险降低的情况下，治疗的益处将持续存在，而低血糖本身也是危重症和非危重症患者不良结局的另一个标志物。在重症监护病房（ICU），开始治疗的阈值为 BG<or=180mg/dL。由于其起效快、作用消退快，静脉内胰岛素是危重症患者的治疗选择。一旦开始静脉内胰岛素，BG 应维持在 140-180mg/dL 之间；在某些患者中，较低的 BG 目标（110-140mg/dL）可能是合适的。不再推荐目标值<110mg/dL 或>180mg/dL。在非危重症患者中，餐前 BG 目标值<140mg/dL；推荐随机 BG<180mg/dL。对于非危重症患者的高血糖，预定的皮下胰岛素是治疗选择；强烈不鼓励使用滑动量表胰岛素。为避免低血糖，如果 BG 降至<100mg/dL，应重新评估胰岛素方案。
医院环境中血糖控制不佳是一个关乎医疗质量、安全和成本的问题。实施最佳血糖控制的安全有效的策略需要多学科参与。在 ICU 中静脉内给予胰岛素或在医院其他部位按预定方案皮下给予胰岛素是治疗的选择。
