Division of Endocrinology, Diabetes & Metabolism, Johns Hopkins University School of Medicine, 1830 E. Monument Street, Suite 333, Baltimore, MD, 21287, USA.
Curr Diab Rep. 2018 Jun 16;18(8):49. doi: 10.1007/s11892-018-1026-0.
Hyperglycemia occurs frequently in hospitalized patients with stroke and peripheral vascular disease (PVD). Guidelines for inpatient glycemic management are not well established for this patient population. We will review the clinical impact of hyperglycemia in this acute setting and review the evidence for glycemic control.
Hyperglycemia in acute stroke is associated with poor short and long-term outcomes, and perioperative hyperglycemia in those undergoing revascularization for PVD is linked to increased post-surgical complications. Studies evaluating tight glucose control do not demonstrate improvement in clinical outcomes, although the risk for hypoglycemia increases substantially. Additional studies are needed to evaluate tight glucose goals relative to our current standard of care and the role of permissive hyperglycemia. Given the limited data to guide glycemic management in these patient populations, it is recommended that general guidelines for inpatient glycemic control be followed. Special considerations should be made to address factors that may impact glucose management, including neurological deficits and clinical changes that occur in the postoperative state.
高血糖在住院脑卒中患者和外周血管疾病（PVD）患者中很常见。针对该患者人群，住院患者血糖管理指南尚未完善。我们将回顾该急性发病环境下高血糖的临床影响，并回顾血糖控制的证据。
急性脑卒中患者的高血糖与短期和长期预后不良有关，而 PVD 血运重建患者的围手术期高血糖与术后并发症增加有关。评估严格血糖控制的研究并未显示临床结局改善，尽管低血糖风险显著增加。需要进一步的研究来评估严格的血糖目标与我们目前的护理标准以及允许性高血糖的作用。鉴于这些患者人群的血糖管理数据有限，建议遵循一般的住院患者血糖控制指南。应特别考虑可能影响血糖管理的因素，包括神经功能缺损和术后发生的临床变化。
