Salinas Pedro D, Mendez Carlos E
1 Aurora Critical Care Services, University of Wisconsin School of Medicine and Public Health, Milwaukee, WI, USA.
2 Froedtert and Medical College of Wisconsin, Division of Diabetes and Endocrinology, Zablocki Veteran Affairs Medical Center, Milwaukee, WI, USA.
J Diabetes Sci Technol. 2019 Jul;13(4):682-690. doi: 10.1177/1932296818822838. Epub 2019 Jan 13.
Hyperglycemia is common in the intensive care unit (ICU) both in patients with and without a previous diagnosis of diabetes. The optimal glucose range in the ICU population is still a matter of debate. Given the risk of hypoglycemia associated with intensive insulin therapy, current recommendations include treating hyperglycemia after two consecutive glucose >180 mg/dL with target levels of 140-180 mg/dL for most patients. The optimal method of sampling glucose and delivery of insulin in critically ill patients remains elusive. While point of care glucose meters are not consistently accurate and have to be used with caution, continuous glucose monitoring (CGM) is not standard of care, nor is it generally recommended for inpatient use. Intravenous insulin therapy using paper or electronic protocols remains the preferred approach for critically ill patients. The advent of new technologies, such as electronic glucose management, CGM, and closed-loop systems, promises to improve inpatient glycemic control in the critically ill with lower rates of hypoglycemia.
高血糖在重症监护病房（ICU）很常见，无论患者之前是否被诊断为糖尿病。ICU患者的最佳血糖范围仍存在争议。鉴于强化胰岛素治疗会带来低血糖风险，目前的建议是，对于大多数患者，在连续两次血糖>180mg/dL后治疗高血糖，目标水平为140 - 180mg/dL。在危重症患者中，最佳的血糖采样方法和胰岛素给药方式仍不明确。虽然即时血糖仪并不总是准确，必须谨慎使用，但连续血糖监测（CGM）并非标准治疗方法，一般也不建议在住院患者中使用。使用纸质或电子方案进行静脉胰岛素治疗仍然是危重症患者的首选方法。新技术的出现，如电子血糖管理、CGM和闭环系统，有望改善危重症患者的住院血糖控制，降低低血糖发生率。
