Endocr Pract. 2020 Feb;26(2):167-173. doi: 10.4158/EP-2018-0524. Epub 2019 Sep 26.
Basal/basal-bolus insulin with discontinuation of home oral antidiabetes medications (OADs) is the preferred method to achieve glycemic control in many hospitalized patients. We hypothesized that a subset of patients with type 2 diabetes mellitus (T2DM) can achieve an acceptable level of blood sugar control without cessation of their OADs when hospitalized. A retrospective chart review was conducted on patients with T2DM who were only on OADs at home, admitted to Fairview Hospital, a community hospital in the Cleveland Clinic Health System. We divided patients into those whose OADs were continued (group 1) and those whose OADs were discontinued (group 2), with or without the addition of insulin in the hospital. Blood glucose (BG) levels and patient characteristics were compared. There were 175 patients, 73 in group 1 and 102 in group 2. The percentage of patients achieving all BG values within 100 to 180 mg/dL was the same between group 1 (21.9%) and group 2 (23.8%) ( = .78). Mean BG was similar between group 1 and group 2 (146.1 ± 41.4 mg/dL versus 152.1 ± 38.9 mg/dL; = .33), with no significant difference in terms of percentage of patients with hyperglycemia or hypoglycemia. A greater proportion of patients in group 1 had an uninterrupted feeding status, nonintensive care unit admission and no contrast dye exposure, and a shorter length of stay. Our study shows that patients with certain characteristics could achieve an acceptable level of glycemic control without cessation of their home OADs. = blood glucose; = dipeptidyl dipeptidase 4; = glomerular filtration rate; = hemoglobin A1c; = intensive care unit; = length of stay; = nil per os; = oral antidiabetes medication; = point of care; = type 2 diabetes mellitus.
在许多住院患者中,停用家庭口服降糖药(OAD)后采用基础/基础-餐时胰岛素方案是控制血糖的首选方法。我们假设,当住院时,一部分 2 型糖尿病(T2DM)患者在不停止使用 OAD 的情况下,可以达到可接受的血糖控制水平。我们对仅在家中使用 OAD 的 T2DM 患者进行了回顾性病历审查,这些患者均收入克利夫兰诊所医疗系统下属费尔维尤医院。我们将患者分为继续使用 OAD(第 1 组)和停用 OAD(第 2 组)两组,无论在住院期间是否添加胰岛素。比较两组的血糖(BG)水平和患者特征。共有 175 例患者,第 1 组 73 例,第 2 组 102 例。第 1 组(21.9%)和第 2 组(23.8%)所有 BG 值在 100-180mg/dL 内的患者比例相同(=0.78)。第 1 组和第 2 组的平均 BG 相似(146.1±41.4mg/dL 与 152.1±38.9mg/dL;=0.33),高血糖或低血糖患者的比例无显著差异。第 1 组中更多的患者有持续进食状态、非重症监护病房入院和无造影剂暴露,且住院时间较短。我们的研究表明,具有某些特征的患者可以在不停止使用家庭 OAD 的情况下达到可接受的血糖控制水平。=血糖;=二肽基肽酶 4;=肾小球滤过率;=糖化血红蛋白;=重症监护病房;=住院时间;=禁食;=口服降糖药;=即时检验;=2 型糖尿病。