Gupta Tina, Hudson Margo
Division of Endocrinology, Diabetes, and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115.
J Endocr Soc. 2017 Feb 22;1(4):247-259. doi: 10.1210/js.2016-1055. eCollection 2017 Apr 1.
Hyperglycemia is a common issue affecting inpatient care. Although this is in part because of the higher rate of hospitalization among patients with preexisting diabetes, multiple factors complicate inpatient glucose management, including acute stress from illness or surgery, erratic dietary intake, and contribution of medications. It has been repeatedly demonstrated that poorly controlled blood glucose levels are associated with negative clinical outcomes, such as increased mortality, higher rate of surgical complications, and longer length of hospital stay. Given these concerns, there has been extensive study of the optimal strategy for management of glucose levels, with the bulk of existing literature focusing on insulin therapy in the intensive care unit setting. This review shifts the focus to the general adult medical and surgical wards, using clinical guidelines and sentinel studies to describe the scientific basis behind the current basal-bolus insulin-based approach to blood sugar management among noncritically ill inpatients. Patient-centered clinical trials looking at alternative dosing regimens and insulin analog and noninsulin agents, such as glucagon-like peptide-1 agonist therapies, introduce safe and effective options in the management of inpatient hyperglycemia. Data from these studies reveal that these approaches are of comparable safety and efficacy to the traditional basal-bolus insulin regimen, and may offer additional benefit in terms of less monitoring requirements and lower rates of hypoglycemia. Although existing data are encouraging, outcome studies will be needed to better establish the clinical impact of these more recently proposed approaches in an effort to broaden and improve current clinical practices in inpatient diabetes care.
高血糖是影响住院治疗的常见问题。虽然部分原因是已有糖尿病患者的住院率较高，但多种因素使住院患者的血糖管理变得复杂，包括疾病或手术引起的急性应激、不规律的饮食摄入以及药物的影响。反复证明，血糖控制不佳与不良临床结局相关，如死亡率增加、手术并发症发生率更高以及住院时间延长。鉴于这些问题，人们对血糖管理的最佳策略进行了广泛研究，现有文献大多聚焦于重症监护病房环境下的胰岛素治疗。本综述将重点转向普通成人内科和外科病房，利用临床指南和标志性研究来描述当前基于基础 - 餐时胰岛素的非危重症住院患者血糖管理方法背后的科学依据。以患者为中心的临床试验研究了替代给药方案以及胰岛素类似物和非胰岛素药物，如胰高血糖素样肽 -1 激动剂疗法，为住院患者高血糖管理引入了安全有效的选择。这些研究的数据表明，这些方法与传统的基础 - 餐时胰岛素方案具有相当的安全性和有效性，并且在减少监测需求和降低低血糖发生率方面可能具有额外益处。尽管现有数据令人鼓舞，但仍需要进行结局研究，以更好地确定这些最近提出的方法的临床影响，从而拓宽和改善当前住院糖尿病护理的临床实践。
