Division of Endocrinology, Diabetes, and Metabolism, Penn State University, Milton S. Hershey Medical Center, Hershey, PA 17033, USA.
Endocr Pract. 2011 Mar-Apr;17(2):249-60. doi: 10.4158/EP10220.RA.
To provide insulin protocols and adjustment guidance for management of hyperglycemia in common inpatient clinical scenarios.
We performed a PubMed search of pertinent existing literature from 1980 to 2010.
Hyperglycemia is frequently encountered in general medical and surgical wards and has been linked to adverse clinical outcomes, prolonged hospital length of stay, and increased institutional care needs after discharge. No randomized controlled trial has been conducted to define optimal glycemic goals or to investigate the effects of intensive glycemic control in the non-intensive care unit (ICU) setting. Nonetheless, it is advocated by the American Association of Clinical Endocrinologists and the American Diabetes Association, in their 2009 Consensus Statement on Inpatient Glycemic Control, that optimization of glycemia in hospitalized patients with diabetes and hyperglycemia be judiciously offered. This approach is clinically sound, in light of the known deleterious consequences of hyperglycemia in critically and noncritically ill patients and the benefits observed with improved glycemic control in intensive care settings. The approach to hyperglycemia in non-ICU inpatients should follow the principles of provision of basal-nutritional-supplemental insulin. Herein we provide insulin protocols and adjustment guidance for management of hyperglycemia in common clinical scenarios. Recommendations reflect the opinion of national experts in the field and our departmental consensus at Penn State Institute for Diabetes and Obesity.
Glycemic control in the non-ICU setting is a relevant clinical situation that should be addressed and managed effectively and prudently. We present a practical guide for management of hyperglycemia individualized to various clinical scenarios encountered in the general hospital wards.
为常见住院临床情况下的高血糖管理提供胰岛素方案和调整指导。
我们对 1980 年至 2010 年的相关现有文献进行了 PubMed 检索。
高血糖在普通内科和外科病房中经常出现，与不良临床结局、住院时间延长以及出院后机构护理需求增加有关。没有随机对照试验来定义最佳血糖目标或研究非重症监护病房（ICU）环境下强化血糖控制的效果。尽管如此，美国临床内分泌医师协会和美国糖尿病协会在其 2009 年住院患者血糖控制共识声明中主张，应明智地为糖尿病和高血糖住院患者优化血糖。鉴于危重和非危重患者高血糖的有害后果以及强化血糖控制在重症监护环境中观察到的益处，这种方法在临床上是合理的。非 ICU 住院患者的高血糖处理应遵循提供基础-营养-补充胰岛素的原则。在此，我们为常见临床情况下的高血糖管理提供了胰岛素方案和调整指导。建议反映了该领域的国家专家的意见和我们在宾夕法尼亚州立大学糖尿病与肥胖研究所的部门共识。
非 ICU 环境下的血糖控制是一个相关的临床情况，应有效和谨慎地处理和管理。我们针对在普通医院病房中遇到的各种临床情况制定了一种实用的高血糖管理指南。
