The Orthopedic Surgery Department, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Diabetes Metab Res Rev. 2012 Jan;28(1):71-5. doi: 10.1002/dmrr.1217.
Hyperglycaemia and diabetes mellitus are common in patients hospitalized in the orthopaedic surgery ward. However, glycaemic control obtained during hospitalization is often suboptimal. No method for achieving adequate glycaemic control in this population has been validated in an in-hospital setting.
An intervention including an intensive subcutaneous insulin protocol in the orthopaedic department.
All diabetic patients admitted to the Department of Orthopaedic Surgery were prospectively randomized during a 6-month period. One group (n = 30) received standard care with sliding scale insulin and the other group (n = 35) received the intervention protocol. During the intervention period, the staff was briefed on the importance of glucose monitoring and control. An intensive multiple-injection protocol consisting of four daily regular/neutral protamine hagedorn (NPH) insulin injections was initiated in diabetic patients. The programme was followed up by a consulting diabetologist.
Mean blood glucose levels throughout the hospitalization were 161.48 ± 3.8 mg/dL in the intervention group versus 175.29 ± 2.3 mg/dL in the control group (p < 0.0005). Hospitalization was shorter by 2 days in the intervention group (p < 0.05). The number of severe hyperglycaemic events (blood glucose level above 400 mg%) was significantly lower (p < 0.05) in the intervention group. There was no significant difference in the number of hypoglycaemic events.
The suggested four-step intervention regimen improved glycaemic control of hospitalized patients in the orthopaedic department and simplified the 'in-house' treatment of the diabetic patient. Hospital stays were reduced on average by two days (p < 0.05).
高血糖和糖尿病在骨科病房住院患者中很常见。然而，住院期间的血糖控制往往并不理想。在住院环境中，尚未验证任何一种方法可以实现这一人群的血糖控制达标。
骨科病房实施一项强化皮下胰岛素方案的干预措施。
在 6 个月期间，前瞻性随机分配所有入住骨科外科病房的糖尿病患者。一组（n = 30）接受常规胰岛素的滑动剂量方案，另一组（n = 35）接受干预方案。在干预期间，工作人员接受了关于血糖监测和控制重要性的培训。对糖尿病患者启动强化多次注射方案，即每日注射 4 次常规/中性鱼精蛋白锌胰岛素（NPH）。该方案由一名会诊糖尿病专家进行随访。
干预组住院期间的平均血糖水平为 161.48 ± 3.8 mg/dL，而对照组为 175.29 ± 2.3 mg/dL（p < 0.0005）。干预组的住院时间缩短了 2 天（p < 0.05）。严重高血糖事件（血糖水平超过 400 mg%）的数量显著减少（p < 0.05）。低血糖事件的数量无显著差异。
建议的四步干预方案改善了骨科住院患者的血糖控制，简化了糖尿病患者的院内治疗。平均住院时间缩短了 2 天（p < 0.05）。
