Division of Endocrinology, Diabetes and Metabolism, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
Nutrition. 2011 Mar;27(3):276-81. doi: 10.1016/j.nut.2010.07.013. Epub 2010 Sep 24.
Hyperglycemia is common in acutely ill hospitalized patients and has been linked to poor outcomes, independent of pre-existing diabetes. Correction of hyperglycemia has been shown to decrease morbidity and mortality; however, establishing evidence-based guidelines has been challenging because insulin intervention studies have varied in the questions they have addressed, glucose levels studied, feeding regimen, and quality of methodology. This article reviews the findings and limitations of recent intervention studies that have addressed treatment of inpatient hyperglycemia with intravenous insulin infusion therapy. Discussion of underlying causes of hospital-related hyperglycemia and mechanisms explaining the deleterious effects of hyperglycemia and improved outcomes with insulin intervention are described. Current guidelines from various professional organizations recommend treatment of inpatient hyperglycemia, although exact glycemic targets and identification of which patient subsets will receive greatest benefit from glucose lowering remain an area of ongoing research.
高血糖在急性住院患者中很常见，并与不良预后相关，而与预先存在的糖尿病无关。高血糖的纠正已被证明可降低发病率和死亡率；然而，由于胰岛素干预研究在其关注的问题、研究的血糖水平、喂养方案和方法质量方面存在差异，因此制定基于证据的指南具有挑战性。本文综述了最近干预研究的结果和局限性，这些研究涉及静脉内胰岛素输注治疗住院患者高血糖。讨论了与医院相关的高血糖的潜在原因以及解释高血糖有害影响和胰岛素干预改善预后的机制。来自不同专业组织的现行指南建议治疗住院患者高血糖，尽管确切的血糖目标和确定哪些患者亚组将从降血糖治疗中获益最大仍然是一个正在进行研究的领域。
