Rafael Machado Tironi, Jean-Charles Preiser
Registrar.
Professor, Department of Intensive Care, Erasme University Hospital, Universite libre de Bruxelles, Brussels, Belgium.
Eur Endocrinol. 2015 Aug;11(2):75-78. doi: 10.17925/EE.2015.11.02.75. Epub 2015 Aug 19.
The 'diabetes of injury' typically associated with critical illness has recently been thoroughly revisited and much better characterised following major therapeutic advances. The occurrence of severe hyperglycaemia, moderate hypoglycaemia or high glycaemic variability has been associated with an increased mortality and rate of complications in large independent cohorts of acutely ill patients. Hence, current guidelines advocate the prevention and avoidance of each of these three dysglycaemic domains, and the use of a common metrics for a quantitative description of dysglycaemic events, such as the proportion of time spent in the target glycaemic range as a unifying variable. Using a common language will help to face the future challenges, including the definition of the most appropriate blood glucose (BG) target according to the category of admission, the time interval from the initial injury and the medical history. The clinical testing of technological improvements in the monitoring systems and the therapeutic algorithms should be assessed using the same metrics.
与危重病相关的“损伤性糖尿病”最近在重大治疗进展后得到了全面重新审视,并得到了更好的描述。在大量独立的急性病患者队列中,严重高血糖、中度低血糖或高血糖变异性的发生与死亡率和并发症发生率增加相关。因此,当前指南提倡预防和避免这三个血糖异常领域中的每一个,并使用通用指标对血糖异常事件进行定量描述,例如将处于目标血糖范围内的时间比例作为统一变量。使用通用语言将有助于应对未来的挑战,包括根据入院类别、初始损伤后的时间间隔和病史来定义最合适的血糖(BG)目标。监测系统和治疗算法技术改进的临床测试应使用相同的指标进行评估。