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[糖皮质激素诱导的高血糖症的管理与治疗]

[Management and Treatment of Glucocorticoid-Induced Hyperglycemia].

作者信息

Paredes Sílvia, Alves Marta

机构信息

Serviço de Endocrinologia. Hospital de Braga. Braga. Portugal; Departamento de Educação e Simulação Médica. Faculdade de Medicina. Universidade do Porto. Porto. Portugal.

Serviço de Endocrinologia. Hospital de Braga. Braga. Portugal.

出版信息

Acta Med Port. 2016 Sep;29(9):556-563. doi: 10.20344/amp.7758. Epub 2016 Sep 30.

Abstract

INTRODUCTION

Glucocorticoids have been associated to several side effects, specially a diabetogenic action, the most common and representative effect. Glucocorticoid-induced hyperglycemia is a common medical condition, with general associated morbidity and mortality.

MATERIAL AND METHODS

It was performed a literature review about the management and treatment of glucocorticoid-induced hyperglycemia.

RESULTS

Through numerous not quite fully understood mechanics, glucocorticoids promote hyperglycemia in non-diabetic patients and worsen diabetes control in diabetic individuals. Glucocorticoid-induced hyperglycemia presents key patterns, enhanced in the postprandial period and scheduled-dependent. Despite the existence of guidelines for hyperglycemia treatment in non-critic hospitalized and non-hospitalized patients, there are no guidelines respecting glucocorticoid-induced hyperglycemia. Nevertheless, it is known that glucocorticoid-induced hyperglycemia is complex and demanding, requiring a specific approach. Indeed, glucocorticoid-induced hyperglycemia treatment depends on the glucocorticoid used, its dose, frequency and schedule. Furthermore, the scheme of treatment previously used by diabetic individuals also influences the choice of the new scheme.

DISCUSSION AND CONCLUSION

The authors reviewed the glucocorticoid induced-hyperglycemia thematic and propose strategies to approach and treat glucocorticoid induced-hyperglycemia in diabetic and non-diabetic individuals. This review is expected to be useful in different settings and crosswise to all medical specialties.

摘要

引言

糖皮质激素与多种副作用相关,尤其是致糖尿病作用,这是最常见且具代表性的效应。糖皮质激素诱导的高血糖是一种常见病症,通常伴有发病率和死亡率。

材料与方法

对糖皮质激素诱导的高血糖的管理和治疗进行了文献综述。

结果

通过众多尚未完全理解的机制,糖皮质激素可促使非糖尿病患者出现高血糖,并使糖尿病患者的血糖控制恶化。糖皮质激素诱导的高血糖呈现出关键模式,在餐后阶段增强且具有时间依赖性。尽管存在针对非重症住院患者和非住院患者高血糖治疗的指南,但尚无关于糖皮质激素诱导的高血糖的指南。然而,已知糖皮质激素诱导的高血糖情况复杂且要求较高,需要采用特定方法。实际上,糖皮质激素诱导的高血糖治疗取决于所使用的糖皮质激素、其剂量、频率和给药时间。此外,糖尿病患者先前使用的治疗方案也会影响新方案的选择。

讨论与结论

作者回顾了糖皮质激素诱导的高血糖这一主题,并提出了针对糖尿病患者和非糖尿病患者处理及治疗糖皮质激素诱导的高血糖的策略。预计本综述在不同环境以及所有医学专科领域都将有所助益。

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