Graves Caran, Faraklas Iris, Cochran Amalia
Burn Center at the University of Utah and Department of Surgery, University of Utah Health Sciences Center, Salt Lake City, UT, United States.
Burns. 2013 Aug;39(5):881-4. doi: 10.1016/j.burns.2012.10.009. Epub 2012 Dec 27.
Rates of diabetes mellitus (DM) are increasing. Early identification and treatment of hyperglycemia in the critical care setting can decrease morbidity and mortality. Many burn centers measure hemoglobin A1c (A1c). This study evaluates the prevalence of pre-existing DM and the utility of using A1c for identifying DM compared with a non-invasive risk assessment.
Adult patients admitted to our regional ABA-verified burn center from July 2008 to July 2009 had A1c levels evaluated and were asked to complete the American Diabetes Association Diabetes Risk Test (DRT).
Forty-one patients consented to participate: 24 patients with burn (19 male) and 17 patients with non-burns (10 male). Non-burn patients had greater BMIs (BMI 32 vs. 28, p=0.093) and had a higher rate of DM prior to admission (35% vs. 17%, p=0.159) than the burn patients. These differences were not statistically significant. Most patients (23/41) were at high risk for developing DM based on the DRT. Patients with pre-existing DM were significantly more likely to have elevated A1c levels (>6.5%) compared with those without pre-existing DM (60% vs. 0%, p<0.001). Compared with history of DM, DRT had a poor positive predictive value of 36% and 50% (burn and non-burn respectively) but a 100% negative predictive value for DM for both groups.
DM and obesity were more common in non-burn patients than in burn patients. A history of DM provides a simple, accurate method for identifying patients with DM. Use of A1c in the ICU provides little additional data for diagnosis of DM and does not impact patient management.
糖尿病（DM）的发病率正在上升。在重症监护环境中早期识别和治疗高血糖可降低发病率和死亡率。许多烧伤中心都检测糖化血红蛋白（A1c）。本研究评估了既往DM的患病率以及与非侵入性风险评估相比，使用A1c识别DM的效用。
2008年7月至2009年7月入住我们地区经美国烧伤协会（ABA）认证的烧伤中心的成年患者接受了A1c水平评估，并被要求完成美国糖尿病协会糖尿病风险测试（DRT）。
41名患者同意参与：24名烧伤患者（19名男性）和17名非烧伤患者（10名男性）。非烧伤患者的体重指数更高（体重指数32 vs. 28，p = 0.093），入院前DM发生率高于烧伤患者（35% vs. 17%，p = 0.159）。这些差异无统计学意义。根据DRT，大多数患者（23/41）有发生DM的高风险。与无既往DM的患者相比，有既往DM的患者A1c水平升高（>6.5%）的可能性显著更高（60% vs. 0%，p<0.001）。与DM病史相比，DRT的阳性预测值较差，烧伤组和非烧伤组分别为36%和50%，但两组对DM的阴性预测值均为100%。
DM和肥胖在非烧伤患者中比在烧伤患者中更常见。DM病史为识别DM患者提供了一种简单、准确的方法。在重症监护病房使用A1c几乎不能为DM诊断提供更多数据，也不影响患者管理。
