Endocr Pract. 2016 Sep;22(9):1040-7. doi: 10.4158/EP151166.OR. Epub 2016 Apr 28.
Inpatient hypoglycemia (glucose ≤70 mg/dL) is a limitation of intensive control with insulin. Causes of hypoglycemia were evaluated in a randomized controlled trial examining intensive glycemic control (IG, target 140 mg/dL) versus moderate glycemic control (MG, target 180 mg/dL) on post-liver transplant outcomes.
Hypoglycemic episodes were reviewed by a multidisciplinary team to calculate and identify contributing pathophysiologic and operational factors. A subsequent subgroup case control (1:1) analysis (with/without) hypoglycemia was completed to further delineate factors. A total of 164 participants were enrolled, and 155 patients were examined in depth.
Overall, insulin-related hypoglycemia was experienced in 24 of 82 patients in IG (episodes: 20 drip, 36 subcutaneous [SQ]) and 4 of 82 in MG (episodes: 2 drip, 2 SQ). Most episodes occurred at night (41 of 60), with high insulin amounts (44 of 60), and during a protocol deviation (51 of 60). Compared to those without hypoglycemia (n = 127 vs. n = 28), hypoglycemic patients had significantly longer hospital stays (13.6 ± 12.6 days vs. 7.4 ± 6.1 days; P = .002), higher peak insulin drip rates (17.4 ± 10.3 U/h vs. 13.1 ± 9.9 U/h; P = .044), and higher peak insulin glargine doses (36.8 ± 21.4 U vs. 26.2 ± 24.3 U; P = .035). In the case-matched analysis (24 cases, 24 controls), those with insulin-related hypoglycemia had higher median peak insulin drip rates (17 U/h vs. 11 U/h; P = .04) and protocol deviations (92% vs. 50%; P = .004).
Peak insulin requirements and protocol deviations were correlated with hypoglycemia.
DM = diabetes mellitus ICU = intensive care unit IG = intensive glycemic control MELD = Model for End-stage Liver Disease MG = moderate glycemic control SQ = subcutaneous.
住院患者低血糖（血糖≤70mg/dL）是胰岛素强化控制的限制。在一项随机对照试验中，评估了强化血糖控制（IG，目标 140mg/dL）与中度血糖控制（MG，目标 180mg/dL）对肝移植后结局的影响，分析了低血糖的原因。
多学科团队回顾低血糖发作情况，计算并确定导致低血糖的病理生理和操作因素。随后进行了低血糖亚组病例对照（1:1）分析（有/无）低血糖，以进一步阐明因素。共纳入 164 名参与者，对 155 名患者进行了深入检查。
IG 组 82 例患者中有 24 例（发作：20 例点滴，36 例皮下 [SQ]），MG 组 82 例患者中有 4 例（发作：2 例点滴，2 例 SQ）出现与胰岛素相关的低血糖。大多数低血糖发作发生在夜间（60 例中的 41 例），使用胰岛素剂量较高（60 例中的 44 例），并且存在方案偏差（60 例中的 51 例）。与无低血糖患者（n=127 与 n=28）相比，低血糖患者的住院时间明显更长（13.6±12.6 天与 7.4±6.1 天；P=0.002），胰岛素滴注率峰值更高（17.4±10.3U/h 与 13.1±9.9U/h；P=0.044），甘精胰岛素峰值剂量更高（36.8±21.4U 与 26.2±24.3U；P=0.035）。在病例匹配分析（24 例病例，24 例对照）中，胰岛素相关低血糖患者的胰岛素滴注率峰值中位数更高（17U/h 与 11U/h；P=0.04），且方案偏差更多（92%与 50%；P=0.004）。
胰岛素需求峰值和方案偏差与低血糖相关。
DM=糖尿病 ICU=重症监护病房 IG=强化血糖控制 MELD=终末期肝病模型 MG=中度血糖控制 SQ=皮下。
