Echouffo-Tcheugui Justin B, Garg Rajesh
Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Harvard Medical School, 221 Longwood Avenue, Boston, MA, 02215, USA.
Curr Diab Rep. 2017 Aug;17(8):56. doi: 10.1007/s11892-017-0883-2.
Hyperglycemia in the emergency department (ED) is being recognized as a public health problem and presents a clinical challenge. This review critically summarizes available evidence on the burden, etiology, diagnosis, and practical management strategies for hyperglycemia in the ED.
Diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) are hyperglycemic emergencies that commonly present to the ED. However, the most common form of hyperglycemia in ED is associated with non-hyperglycemic medical emergencies. The presence of hyperglycemia increases the mortality and morbidity associated with the primary condition. The related hospital admission rates and costs are also elevated. The frequency of DKA or HHS related mortality and morbidity has remained high over the last decade. However, attempts have been made to improve management of all hyperglycemia in the ED. Evidence suggests that better management of hyperglycemia in the ED with proper follow-up improves clinical outcomes and prevents readmission. Optimization of the hyperglycemia management in the ED may improve clinical outcomes. However, more clinical trial data on the outcomes and cost-effectiveness of various management strategies or protocols are needed.
急诊科高血糖正被视为一个公共卫生问题，并带来临床挑战。本综述批判性地总结了关于急诊科高血糖的负担、病因、诊断及实际管理策略的现有证据。
糖尿病酮症酸中毒（DKA）和高血糖高渗状态（HHS）是常出现在急诊科的高血糖急症。然而，急诊科最常见的高血糖形式与非高血糖医疗急症相关。高血糖的存在会增加与原发疾病相关的死亡率和发病率。相关的住院率和费用也会升高。在过去十年中，DKA或HHS相关的死亡率和发病率一直居高不下。不过，人们已尝试改善急诊科所有高血糖的管理。有证据表明，在急诊科对高血糖进行更好的管理并进行适当随访可改善临床结局并预防再次入院。优化急诊科高血糖管理可能会改善临床结局。然而，需要更多关于各种管理策略或方案的结局及成本效益的临床试验数据。
