Hulkower Raphael D, Pollack Rena M, Zonszein Joel
Department of Medicine, Jacobi Medical Center, NY, USA.
Department of Clinical Medicine, Albert Einstein College of Medicine & Clinical Diabetes Center, Division of Endocrinology & Metabolism, Montefiore Medical Center, the University Hospital for Albert Einstein College of Medicine, Clinical Diabetes Center, 1825 Eastchester Road, Bronx, NY 10461 USA.
Diabetes Manag (Lond). 2014 Mar;4(2):165-176. doi: 10.2217/DMT.13.73.
Controlling blood glucose in hospitalized patients is important as both hyperglycemia and hypoglycemia are associated with increased cost, length of stay, morbidity and mortality. A limiting factor in stringent control is the concern of iatrogenic hypoglycemia. The association of hypoglycemia with mortality has led to clinical guideline changes recommending more conservative glycemic control than had previously been suggested, with the use of patient specific approaches when appropriate. Healthier, stable patients may be managed with stricter control while the elderly and severely ill may be managed less aggressively. While the avoidance of hypoglycemia is essential in clinical practice, recent studies suggest that a higher mortality rate occurs in spontaneous rather than iatrogenic hypoglycemia. Therefore, inpatient hypoglycemia may be viewed more as a biomarker of disease rather than a true cause of fatality.
控制住院患者的血糖很重要，因为高血糖和低血糖都与成本增加、住院时间延长、发病率和死亡率升高有关。严格控制血糖的一个限制因素是对医源性低血糖的担忧。低血糖与死亡率之间的关联导致临床指南发生变化，建议采用比以前更保守的血糖控制方法，并在适当的时候采用针对患者个体的方法。健康、稳定的患者可以采用更严格的控制措施，而老年人和重症患者则可以采取不那么激进的管理方式。虽然在临床实践中避免低血糖至关重要，但最近的研究表明，自发性低血糖而非医源性低血糖的死亡率更高。因此，住院患者低血糖可能更多地被视为疾病的生物标志物，而不是真正的死亡原因。
