Lucas Martín Anna M, Guanyabens Elena, Zavala-Arauco R, Chamorro Joaquín, Granada Maria Luisa, Mauricio Didac, Puig-Domingo Manuel
Endocrinology and Nutrition Service, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain.
Hormone Laboratory, Germans Trias i Pujol Research Institute and Hospital, Department of Medicine, Autonomous University of Barcelona, Can Ruti Campus, Ctra. Canyet s/n, Badalona, 08916 Barcelona, Spain.
Int J Endocrinol. 2015;2015:381415. doi: 10.1155/2015/381415. Epub 2015 May 18.
Type 2 diabetes (T2D) exists in 25-40% of hospitalized patients. Therapeutic inertia is the delay in the intensification of a treatment and it is frequent in T2D. The objectives of this study were to detect patients admitted to surgical wards with hyperglycaemia (HH; fasting glycaemia > 140 mg/dL) as well as those with T2D and suboptimal chronic glycaemic control (SCGC) and to assess the midterm impact of treatment modifications indicated at discharge. A total of 412 HH patients were detected in a period of 18 months; 86.6% (357) had a diagnosed T2D. Their preadmittance HbA1c was 7.7 ± 1.5%; 47% (189) had HbA1c ≥ 7.4% (SCGC) and were moved to the upper step in the therapeutic algorithm at discharge. Another 15 subjects (3.6% of the cohort) had T2D according to their current HbA1c. Ninety-four of the 189 SCGC patients were evaluated 3-6 months later. Their HbA1c before in-hospital-intervention was 8.6 ± 1.2% and 7.5 ± 1.2% at follow-up (P < 0.004). Active detection of hyperglycaemia in patients admitted in conventional surgical beds permits the identification of T2D patients with SCGC as well as previously unknown cases. A shift to the upper step in the therapeutic algorithm at discharge improves this control. Hospitalization is an opportunity to break therapeutic inertia.
2型糖尿病（T2D）存在于25%-40%的住院患者中。治疗惰性是指治疗强化的延迟，在T2D患者中很常见。本研究的目的是检测入住外科病房的高血糖（HH；空腹血糖>140mg/dL）患者以及T2D且慢性血糖控制不佳（SCGC）的患者，并评估出院时所指示的治疗调整的中期影响。在18个月的时间里共检测到412例HH患者；86.6%（357例）已确诊为T2D。他们入院前的糖化血红蛋白（HbA1c）为7.7±1.5%；47%（189例）的HbA1c≥7.4%（SCGC），并在出院时进入治疗方案的更高阶段。另外15名受试者（占队列的3.6%）根据其当前的HbA1c诊断为T2D。189例SCGC患者中的94例在3-6个月后接受了评估。他们住院干预前的HbA1c为8.6±1.2%，随访时为7.5±1.2%（P<0.004）。对入住传统外科病床的患者进行高血糖的主动检测，可以识别出SCGC的T2D患者以及之前未知的病例。出院时转向治疗方案的更高阶段可改善这种控制。住院是打破治疗惰性的一个契机。
