Ma Wan-Xia, Ran Xing-Wu
Diabetic Foot Care Center, Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu 610041, China.
Sichuan Da Xue Xue Bao Yi Xue Ban. 2020 Mar;51(2):146-150. doi: 10.12182/20200360606.
Based on the higher mortality and the higher proportion of critically ill adults in coronavirus disease 2019 (COVID-19) patients with diabetes, good inpatient glycemic control is particularly important in the comprehensive treatment of COVID-19. Individualized blood glucose target goals and treatment strategies should be made according to specific circumstances of COVID-19 inpatients with diabetes. For mild patients, a strict glycemic control target (fasting plasma glucose (FPG) 4.4-6.1 mmol/L, 2-hour postprandial plasma glucose (2 h PG) 6.1-7.8 mmol/L) are recommended; a target for the glycemic control of common type patients (FPG 6.1-7.8 mmol/L, 2 h PG 7.8-10.0 mmol/L) and subcutaneous insulin deliver therapy are recommended; a target nonfasting blood glucose range of 10.0 mmol or less per liter for severe-type COVID-19 patients, a relatively Less stringent blood glucose control target (FPG 7.8-10.0 mmol/L, 2 h PG 7.8-13.9 mmol/L) for critically ill patients and intravenous insulin infusion therapy are recommended. Due to the rapid changes in the condition of some patients, the risk of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar status (HHS) maybe occur during the treatment. Blood glucose monitoring, dynamic evaluation and timely adjustment of strategies should be strengthened to ensure patient safety and promote early recovery of patients.
鉴于2019冠状病毒病(COVID-19)合并糖尿病患者的死亡率较高且危重症成人比例较高,良好的住院血糖控制在COVID-19的综合治疗中尤为重要。应根据COVID-19合并糖尿病住院患者的具体情况制定个体化的血糖目标和治疗策略。对于轻症患者,建议采用严格的血糖控制目标(空腹血糖(FPG)4.4-6.1 mmol/L,餐后2小时血糖(2 h PG)6.1-7.8 mmol/L);对于普通型患者,建议血糖控制目标为(FPG 6.1-7.8 mmol/L,2 h PG 7.8-10.0 mmol/L)并采用皮下胰岛素注射治疗;对于重型COVID-19患者,建议非空腹血糖目标范围为每升10.0 mmol或更低,对于危重症患者,建议采用相对宽松的血糖控制目标(FPG 7.8-10.0 mmol/L,2 h PG 7.8-13.9 mmol/L)并采用静脉胰岛素输注治疗。由于部分患者病情变化迅速,治疗期间可能会发生糖尿病酮症酸中毒(DKA)或高血糖高渗状态(HHS)。应加强血糖监测、动态评估并及时调整策略,以确保患者安全并促进患者早日康复。