Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
Department of Emergency Medicine, Hennepin County Medical Center, Minneapolis, MN, USA.
Am J Emerg Med. 2019 Jul;37(7):1295-1300. doi: 10.1016/j.ajem.2018.09.053. Epub 2018 Oct 5.
Hyperglycemia is commonly encountered in the ED; the importance of glucose reduction in patients well enough to be discharged is unknown.
We conducted a prospective, randomized trial of ED patients with hyperglycemia with a glucose value 400-600 mg/dL who were discharged from the ED, excluding those with type 1 diabetes mellitus. Patients were randomly assigned to a discharge glucose goal, <350 mg/dL (moderate control) or < 600 mg/dL (loose control). The primary outcome was ED length of stay.
Among 110 enrolled patients, 57 were assigned to moderate and 53 to loose glycemic control. Median (IQR) length of stay was 211 min (177-288 min) for the moderate group and 216 min (151-269 min) for the loose group (difference, 17 min [95% CI -15 to 49 min]). ED length of stay for those with an actual discharge glucose <350 mg/dL was 29 min longer (95% CI -1 to 59 min). Repeat ED visits for hyperglycemia (7% vs 6%), hospitalization for hyperglycemia (0% vs 2%), and hospitalization for any reason (4% vs 8%) did not differ significantly between groups.
In the intention-to-treat analysis, ED length of stay and 7-day outcomes were not significantly different whether moderate or loose glycemic control was pursued. However, the length of stay for those with discharge glucose <350 mg/dL was approximately 29 min longer. ED glycemic control did not appear to be associated negative short-term outcomes. Glucose reduction in well-appearing ED patients may consume time and resources without conferring short- or long-term benefits.
Clinicaltrials.govNCT02478190.
急诊科（ED）经常会出现高血糖症；对于那些身体状况足以出院的患者，血糖降低的重要性尚不清楚。
我们对 ED 中血糖值为 400-600mg/dL 且已出院的高血糖症患者进行了一项前瞻性、随机试验，排除了 1 型糖尿病患者。患者被随机分配到出院时的血糖目标值，<350mg/dL（中等控制）或<600mg/dL（宽松控制）。主要结局是 ED 住院时间。
在 110 名入组患者中，57 名被分配到中等血糖控制组，53 名被分配到宽松血糖控制组。中等组的中位（IQR）住院时间为 211 分钟（177-288 分钟），宽松组为 216 分钟（151-269 分钟）（差异为 17 分钟[95%CI-15 至 49 分钟]）。实际出院血糖<350mg/dL 的患者 ED 住院时间延长 29 分钟（95%CI-1 至 59 分钟）。因高血糖再次就诊 ED（7%比 6%）、因高血糖住院（0%比 2%）和因任何原因住院（4%比 8%）在两组间无显著差异。
在意向治疗分析中，无论是采用中等还是宽松的血糖控制，ED 住院时间和 7 天结局均无显著差异。然而，出院时血糖<350mg/dL 的患者的住院时间延长了约 29 分钟。ED 血糖控制似乎与短期不良结局无关。在表现良好的 ED 患者中降低血糖可能会消耗时间和资源，而不会带来短期或长期益处。
Clinicaltrials.govNCT02478190。
