Emory University School of Medicine, Atlanta, Georgia.
Main Line Health System, University of Pennsylvania, Philadelphia, Pennsylvania.
Endocr Pract. 2014 Sep;20(9):933-44. doi: 10.4158/EP13471.RA.
Hyperglycemia is common in hospitalized patients with and without prior history of diabetes and is an independent marker of morbidity and mortality in critically and noncritically ill patients. Tight glycemic control using insulin has been shown to reduce cardiac morbidity and mortality in hospitalized patients, but it also results in hypoglycemic episodes, which have been linked to poor outcomes. Thus, alternative treatment options that can normalize blood glucose levels without undue hypoglycemia are being sought. Incretin-based therapies, such as glucagon-like peptide (GLP)-1 receptor agonists (RAs) and dipeptidyl peptidase (DPP)-4 inhibitors, may have this potential.
A PubMed database was searched to find literature describing the use of incretins in hospital settings. Title searches included the terms "diabetes" (care, management, treatment), "hospital," "inpatient," "hypoglycemia," "hyperglycemia," "glycemic," "incretin," "dipeptidyl peptidase-4 inhibitor," "glucagon-like peptide-1," and "glucagon-like peptide-1 receptor agonist."
The preliminary research experience with native GLP-1 therapy has shown promise, achieving improved glycemic control with a low risk of hypoglycemia, counteracting the hyperglycemic effects of stress hormones, and improving cardiac function in patients with heart failure and acute ischemia. Large, randomized controlled clinical trials are necessary to determine whether these favorable results will extend to the use of GLP-1 RAs and DPP-4 inhibitors.
This review offers hospitalist physicians and healthcare providers involved in inpatient diabetes care a pathophysiologic-based approach for the use of incretin agents in patients with hyperglycemia and diabetes, as well as a summary of benefits and concerns of insulin and incretin-based therapy in the hospital setting.
高血糖在伴有和不伴有既往糖尿病史的住院患者中很常见，是危重症和非危重症患者发病率和死亡率的独立标志物。使用胰岛素进行严格的血糖控制已被证明可降低住院患者的心脏发病率和死亡率，但也会导致低血糖发作，而低血糖与不良结局有关。因此，正在寻找可以在不引起不当低血糖的情况下使血糖水平正常化的替代治疗方法。基于肠促胰岛素的治疗方法，如胰高血糖素样肽（GLP）-1 受体激动剂（RAs）和二肽基肽酶（DPP）-4 抑制剂，可能具有这种潜力。
使用 PubMed 数据库搜索描述在医院环境中使用肠促胰岛素的文献。标题搜索包括以下术语：“糖尿病”（护理、管理、治疗）、“医院”、“住院”、“低血糖”、“高血糖”、“血糖”、“肠促胰岛素”、“二肽基肽酶-4 抑制剂”、“胰高血糖素样肽-1”和“胰高血糖素样肽-1 受体激动剂”。
天然 GLP-1 治疗的初步研究经验显示出了希望，实现了改善的血糖控制，低血糖风险低，对抗应激激素的高血糖作用，并改善心力衰竭和急性缺血患者的心脏功能。需要进行大型、随机对照临床试验，以确定这些有利结果是否会扩展到 GLP-1 RAs 和 DPP-4 抑制剂的使用。
本综述为住院医师和参与住院糖尿病护理的医疗保健提供者提供了一种基于病理生理学的方法，用于治疗高血糖和糖尿病患者使用肠促胰岛素，以及胰岛素和肠促胰岛素治疗在医院环境中的益处和关注点的摘要。
