Solís Iván, Hurtado Natalia, Demangel Dominique, Cortés Claudia, Soto Néstor
Unidad de Endocrinología y Diabetes, Servicio de Medicina Interna, Departamento de Medicina, Universidad de Chile, Santiago, Chile.
Rev Med Chil. 2012 Jan;140(1):66-72. Epub 2012 Apr 12.
During hospitalization, hyper and hypoglycemia impairs the prognosis of diabetic patients. Strict glycemic control improves survival in intensive care units. There is no evidence to support it for patients in non-critical wards.
To evaluate the glycemic control of diabetic patients in a non-critical medical unit, and estimate its effect on hospitalization and survival.
Prospective study of all patients admitted to a non-critical ward with a fasting blood glucose (BG) > 126 mg/dl or > 200 mg /dl at any time, and patients with known diabetes. Age, sex, type of diabetes, time since diagnosis, chronic complications, prior treatment, length of stay, admission and discharge diagnosis were registered. All capillary BG levels obtained from each patient until discharge, death or transfer, were registered.
Ninety nine patients aged 63 ± 13.4 years (42 males,) were included. Ninety one percent had a type 2 diabetes with a mean duration of 13.8 years. Mean hospital stay was 10.9 days. At least one hypoglycemia below 70 mg/dl occurred in 21% of patients and 39.4% had at least one episode with blood glucose over 300 mg/dl. Median hospital stay of patients with no episode of BG > 200 mg/dl was 6 days, 10.5 days among patients with at least one episode of BG > 300 mg/dl and 13 days among patients that had at least one episode of hypoglycemia (p = 0.02). Diabetes lasted nine years more among the latter (p < 0.01). Three patients that suffered hypoglycemia and two in the rest of the groups, died (NS).
Two of three diabetic patients admitted to our non-critical medical ward have a non-optimal glycemic control. Appearance of hypoglycemia is associated with a longer hospital stay.
住院期间，高血糖和低血糖会损害糖尿病患者的预后。严格的血糖控制可提高重症监护病房患者的生存率。但对于非重症病房的患者，尚无证据支持这一做法。
评估非重症内科病房糖尿病患者的血糖控制情况，并估计其对住院时间和生存率的影响。
对所有入住非重症病房、空腹血糖（BG）>126mg/dl或任何时间血糖>200mg/dl的患者以及已知糖尿病患者进行前瞻性研究。记录年龄、性别、糖尿病类型、诊断后的时间、慢性并发症、既往治疗情况、住院时间、入院和出院诊断。记录每位患者直至出院、死亡或转院时获得的所有毛细血管血糖水平。
纳入99例年龄为63±13.4岁的患者（42例男性）。91%患有2型糖尿病，平均病程为13.8年。平均住院时间为10.9天。21%的患者至少发生一次血糖低于70mg/dl的低血糖，39.4%的患者至少有一次血糖超过300mg/dl的情况。无血糖>200mg/dl发作的患者中位住院时间为6天，至少有一次血糖>300mg/dl发作的患者为10.5天，至少有一次低血糖发作的患者为13天（p=0.02）。后者的糖尿病病程多9年（p<0.01）。3例发生低血糖的患者和其他组中的2例患者死亡（无显著性差异）。
入住我们非重症内科病房的糖尿病患者中，三分之二的患者血糖控制不理想。低血糖的出现与住院时间延长有关。
