University of Pittsburgh, Division of Endocrinology, Department of Medicine, Pittsburgh, PA, USA.
National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, MD, USA.
J Clin Endocrinol Metab. 2022 Jul 14;107(8):2101-2128. doi: 10.1210/clinem/dgac278.
Adult patients with diabetes or newly recognized hyperglycemia account for over 30% of noncritically ill hospitalized patients. These patients are at increased risk for adverse clinical outcomes in the absence of defined approaches to glycemic management.
To review and update the 2012 Management of Hyperglycemia in Hospitalized Patients in Non-Critical Care Settings: An Endocrine Society Clinical Practice Guideline and to address emerging areas specific to the target population of noncritically ill hospitalized patients with diabetes or newly recognized or stress-induced hyperglycemia.
A multidisciplinary panel of clinician experts, together with a patient representative and experts in systematic reviews and guideline development, identified and prioritized 10 clinical questions related to inpatient management of patients with diabetes and/or hyperglycemia. The systematic reviews queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations.
The panel agreed on 10 frequently encountered areas specific to glycemic management in the hospital for which 15 recommendations were made. The guideline includes conditional recommendations for hospital use of emerging diabetes technologies including continuous glucose monitoring and insulin pump therapy; insulin regimens for prandial insulin dosing, glucocorticoid, and enteral nutrition-associated hyperglycemia; and use of noninsulin therapies. Recommendations were also made for issues relating to preoperative glycemic measures, appropriate use of correctional insulin, and diabetes self-management education in the hospital. A conditional recommendation was made against preoperative use of caloric beverages in patients with diabetes.
The recommendations are based on the consideration of important outcomes, practicality, feasibility, and patient values and preferences. These recommendations can be used to inform system improvement and clinical practice for this frequently encountered inpatient population.
患有糖尿病或新诊断为高血糖的成年患者占非重症住院患者的 30%以上。这些患者如果没有明确的血糖管理方法，发生不良临床结局的风险会增加。
回顾和更新 2012 年《非重症监护环境下住院患者血糖管理：内分泌学会临床实践指南》，并针对新诊断或应激性高血糖的非重症住院糖尿病患者这一特定目标人群的新兴领域进行探讨。
由临床医生专家组成的多学科小组，以及一名患者代表和系统评价及指南制定方面的专家，共同确定并优先考虑了 10 个与糖尿病和/或高血糖患者住院管理相关的临床问题。系统评价通过电子数据库查询与选定问题相关的研究。使用推荐评估、制定与评价（GRADE）方法学评估证据的确定性并提出建议。
专家组就 10 个与医院血糖管理密切相关的特定领域达成一致，提出了 15 项建议。该指南包括对新兴糖尿病技术在医院应用的条件性推荐，包括连续血糖监测和胰岛素泵治疗；用于餐前胰岛素给药、糖皮质激素和肠内营养相关高血糖的胰岛素方案；以及非胰岛素治疗的应用。该指南还针对术前血糖测量、校正胰岛素的合理应用以及医院内糖尿病自我管理教育等问题提出了建议。专家组还对糖尿病患者术前使用含热量饮料提出了条件性反对意见。
这些建议基于对重要结局、实用性、可行性以及患者价值观和偏好的考虑。这些建议可用于为这一常见住院人群提供系统改进和临床实践的信息。
