Schwartz Stanley S, DeFronzo Ralph A, Umpierrez Guillermo E
Affiliate, Main Line Health System, Clinical Associate Professor of Medicine Emeritus, University of Pennsylvania , Philadelphia, PA , USA.
Postgrad Med. 2015 Mar;127(2):251-7. doi: 10.1080/00325481.2015.996504. Epub 2014 Dec 30.
Hyperglycemia in patients with and without a prior history of diabetes is an independent marker of morbidity and mortality in critically and noncritically ill patients. Improvement of glycemic control with insulin therapy has been shown to reduce hospital complications in patients with diabetes, but also results in increased rates of hypoglycemia, 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-1 receptor agonists and dipeptidyl peptidase-4 inhibitors, stimulate insulin secretion in a glucose-dependent fashion, thus not causing hypoglycemia. Alternative points of view exist regarding insulin versus incretin therapy for the care of these patients. We have brought together the authors on the opposite sides of this discussion with the objective of providing a rational synthesis on how to achieve the best possible control of glycemia in the hospital, using both standard insulin approaches and incretin-based therapies to improve patient outcomes. This review examines the benefits of incretin-based therapy in improving glycemic control in hospitalized patients with stress-induced diabetes and in diabetic patients in critical care and non-critical care settings.
有或无糖尿病病史患者的高血糖是危重症和非危重症患者发病和死亡的独立标志物。胰岛素治疗改善血糖控制已被证明可减少糖尿病患者的医院并发症，但也会导致低血糖发生率增加，而低血糖与不良预后相关。因此，正在寻求能够使血糖水平正常化而不会出现过度低血糖的替代治疗方案。基于肠促胰素的疗法，如胰高血糖素样肽-1受体激动剂和二肽基肽酶-4抑制剂，以葡萄糖依赖的方式刺激胰岛素分泌，因此不会导致低血糖。关于胰岛素与肠促胰素疗法用于这些患者的治疗存在不同观点。我们召集了这场讨论中持相反观点的作者，目的是就如何在医院中通过标准胰岛素方法和基于肠促胰素的疗法实现最佳血糖控制提供合理的综合意见，以改善患者预后。本综述探讨了基于肠促胰素的疗法在改善应激性糖尿病住院患者以及重症和非重症监护环境下糖尿病患者血糖控制方面的益处。
