Dept. for Anesthesiology and Intensive Care Medicine, University Hospital of the Friedrich-Schiller University Jena, Jena, Germany; German Center for Diabetes Research (DZD), Neuherberg, Germany; King´s College London, Department of Diabetes, School of Life Course Science, London, UK; Institute for Diabetes Research and Metabolic Diseases (IDM) of the Helmholtz Center Munich at the University of Tübingen, Germany; Division IV (Diabetology, Endocrinology, Nephrology) of the Department of Internal Medicine at the University Hospital Tübingen, Germany; Practice for Diabetology and Endocrinology, Dr. Kielstein, Outpatient Healthcare Center Erfurt, Jena.
Dtsch Arztebl Int. 2021 Sep 24;118(38):629-636. doi: 10.3238/arztebl.m2021.0221. Epub 2021 Sep 17.
30-80% of patients being treated in intensive care units in the perioperative period develop hyperglycemia. This stress hyperglycemia is induced and maintained by inflammatory-endocrine and iatrogenic stimuli and generally requires treatment. There is uncertainty regarding the optimal blood glucose targets for patients with diabetes mellitus.
This review is based on pertinent publications retrieved by a selective search in PubMed and Google Scholar.
Patients in intensive care with pre-existing diabetes do not benefit from blood sugar reduction to the same extent as metabolically healthy individuals, but they, too, are exposed to a clinically relevant risk of hypoglycemia. A therapeutic range from 4.4 to 6.1 mmol/L (79-110 mg/dL) cannot be justified for patients with diabetes mellitus. The primary therapeutic strategy in the perioperative setting should be to strictly avoid hypoglycemia. Neurotoxic effects and the promotion of wound-healing disturbances are among the adverse consequences of hyperglycemia. Meta-analyses have shown that an upper blood sugar limit of 10 mmol/L (180 mg/dL) is associated with better outcomes for diabetic patients than an upper limit of less than this value. The target range of 7.8-10 mmol/L (140-180 mg/dL) proposed by specialty societies for hospitalized patients with diabetes seems to be the best compromise at present for optimizing clinical outcomes while avoiding hypoglycemia. The method of choice for achieving this goal in intensive care medicine is the continuous intravenous administration of insulin, requirng standardized, high-quality monitoring conditions.
Optimal blood sugar control for diabetic patients in intensive care meets the dual objectives of avoiding hypoglycemia while keeping the blood glucose concentration under 10 mmol/L (180 mg/dL). Nutrition therapy in accordance with the relevant guidelines is an indispensable pre - requisite.
围手术期在重症监护病房治疗的患者中有 30-80%会出现高血糖。这种应激性高血糖是由炎症-内分泌和医源性刺激诱导和维持的，通常需要治疗。对于糖尿病患者，最佳血糖目标值存在不确定性。
本综述基于在 PubMed 和 Google Scholar 中进行选择性搜索检索到的相关出版物。
患有糖尿病的重症监护患者从血糖降低中获益的程度不如代谢健康的个体，但他们也面临着临床相关的低血糖风险。对于糖尿病患者，4.4 至 6.1mmol/L（79-110mg/dL）的治疗范围不能得到证明。在围手术期，主要的治疗策略应该是严格避免低血糖。高血糖的不良后果包括神经毒性作用和促进伤口愈合障碍。荟萃分析表明，对于糖尿病患者，血糖上限为 10mmol/L（180mg/dL）优于低于此值的血糖上限。目前，专业学会为住院糖尿病患者提出的 7.8-10mmol/L（140-180mg/dL）的目标范围似乎是在避免低血糖的同时优化临床结果的最佳折衷方案。重症监护医学中实现这一目标的首选方法是连续静脉输注胰岛素，需要标准化、高质量的监测条件。
重症监护中糖尿病患者的最佳血糖控制既要避免低血糖，又要将血糖浓度控制在 10mmol/L（180mg/dL）以下。根据相关指南进行营养治疗是必不可少的前提。
