Pollom R Daniel
Diabetes Care Center, Community Health Network, Indianapolis, IN 46216, USA.
Hosp Pract (1995). 2010 Nov;38(4):98-107. doi: 10.3810/hp.2010.11.346.
Hyperglycemia is highly prevalent in the acute-care setting and is associated with an increased risk of morbidity and mortality. Evidence suggests that glycemic control in this population is suboptimal, due in part to continued use of nonphysiologic sliding-scale insulin strategies without scheduled basal insulin doses or prandial insulin with concomitant correction doses. Although the ineffectiveness and risks of sliding-scale insulin regimens have been criticized for decades, sliding-scale insulin is still the most commonly prescribed subcutaneous insulin regimen among inpatients. Improving inpatient management requires the use of scheduled basal-bolus insulin therapy that includes basal insulin, nutritional insulin, and supplemental, or correctional, insulin. Insulin analogs are the preferred insulins, as they provide a more physiologic action than human insulin regimens, are associated with a lower risk of hypoglycemia, and are more convenient to administer than human insulins. Standardized insulin protocols and subcutaneous insulin order sets are critical components of effective inpatient glycemic control. Although preliminary data have demonstrated that inpatient diabetes management programs involving basal-bolus insulin therapy are effective and well tolerated, more research is needed.
高血糖在急性护理环境中极为普遍，且与发病率和死亡率增加相关。有证据表明，该人群的血糖控制并不理想，部分原因是持续使用非生理性的按血糖水平调整胰岛素剂量策略，未给予预定的基础胰岛素剂量或餐时胰岛素加校正剂量。尽管按血糖水平调整胰岛素方案的无效性和风险已被批评数十年，但按血糖水平调整胰岛素仍是住院患者中最常用的皮下胰岛素给药方案。改善住院患者管理需要采用预定的基础 - 餐时胰岛素治疗，包括基础胰岛素、营养性胰岛素以及补充性或校正性胰岛素。胰岛素类似物是首选胰岛素，因为它们比人胰岛素方案具有更符合生理的作用，低血糖风险更低，且比人胰岛素更便于给药。标准化胰岛素方案和皮下胰岛素医嘱集是有效控制住院患者血糖的关键组成部分。尽管初步数据表明，涉及基础 - 餐时胰岛素治疗的住院糖尿病管理项目有效且耐受性良好，但仍需要更多研究。
