Discipline of Acute Care Medicine, Department of Surgical Specialties, Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia.
Intensive Care Unit, Division of Critical Care and Investigative Services, Royal Melbourne Hospital, Parkville, VIC, Australia.
Crit Care Med. 2021 Apr 1;49(4):636-649. doi: 10.1097/CCM.0000000000004810.
There is very limited information about glycemic control after discharge from the ICU. The aims of this study were to evaluate the prevalence of hypoglycemia in ICU survivors with type-2 diabetes and determine whether hypoglycemia is associated with cardiac arrhythmias.
Prospective, observational, two-center study. Participants underwent up to 5 days of simultaneous blinded continuous interstitial glucose monitoring and ambulatory 12-lead electrocardiogram monitoring immediately after ICU discharge during ward-based care. Frequency of arrhythmias, heart rate variability, and cardiac repolarization markers were compared between hypoglycemia (interstitial glucose ≤ 3.5 mmol/L) and euglycemia (5-10 mmol/L) matched for time of day.
Mixed medical-surgical ICUs in two geographically distinct university-affiliated hospitals.
Patients with type-2 diabetes who were discharged from ICU after greater than or equal to 24 hours with greater than or equal to one organ failure and were prescribed subcutaneous insulin were eligible.
Thirty-one participants (mean ± sd, age 65 ± 13 yr, glycated hemoglobin 64 ± 22 mmol/mol) were monitored for 101 ± 32 hours post-ICU (total 3,117 hr). Hypoglycemia occurred in 12 participants (39%; 95% CI, 22-56%) and was predominantly nocturnal (40/51 hr) and asymptomatic (25/29 episodes). Participants experiencing hypoglycemia had 2.4 ± 0.7 discrete episodes lasting 45 minutes (interquartile range, 25-140 min). Glucose nadir was less than or equal to 2.2 mmol/L in 34% of episodes. The longest episode of nocturnal hypoglycemia was 585 minutes with glucose nadir less than 2.2 mmol/L. Simultaneous electrocardiogram and continuous interstitial glucose monitoring recordings were obtained during 44 hours of hypoglycemia and 991 hours of euglycemia. Hypoglycemia was associated with greater risk of bradycardia but did not affect atrial or ventricular ectopics, heart rate variability, or cardiac repolarization.
In ICU survivors with insulin-treated type-2 diabetes, hypoglycemia occurs frequently and is predominantly nocturnal, asymptomatic, and prolonged.
有关 ICU 出院后血糖控制的信息非常有限。本研究旨在评估 2 型糖尿病 ICU 幸存者低血糖的发生率，并确定低血糖是否与心律失常有关。
前瞻性、观察性、双中心研究。参与者在 ICU 出院后立即在病房接受为期 5 天的连续盲法间质葡萄糖监测和 12 导联动态心电图监测。将低血糖（间质葡萄糖≤3.5mmol/L）与血糖正常（5-10mmol/L）组进行比较，两组患者按时间匹配。
两家地理位置不同的大学附属医院的混合内科-外科 ICU。
符合下列条件的 2 型糖尿病患者，在 ICU 住院时间超过 24 小时，有 1 个以上器官衰竭，接受皮下胰岛素治疗，有资格参加研究。
31 名参与者（平均年龄 65±13 岁，糖化血红蛋白 64±22mmol/mol）接受了 101±32 小时的 ICU 后监测（共 3117 小时）。12 名参与者（39%；95%CI，22-56%）发生低血糖，主要发生在夜间（40/51 小时）和无症状（29/29 次）。发生低血糖的参与者有 2.4±0.7 次离散发作，持续 45 分钟（四分位间距，25-140 分钟）。有 34%的发作时血糖最低值≤2.2mmol/L。最长的夜间低血糖发作持续 585 分钟，血糖最低值<2.2mmol/L。在 44 小时的低血糖和 991 小时的血糖正常期间同时记录心电图和连续间质葡萄糖监测。低血糖与心动过缓风险增加有关，但不影响房性或室性早搏、心率变异性或心脏复极。
在接受胰岛素治疗的 2 型糖尿病 ICU 幸存者中，低血糖经常发生，主要发生在夜间，无症状且持续时间较长。
