Division of Endocrinology and Metabolism Department of Internal Medicine and Epidemiology S.E.S. University Hospital of Caldas University of Caldas, Manizales, Colombia.
Department of Internal Medicine University of Caldas, Manizales, Colombia.
J Diabetes Res. 2024 Aug 27;2024:3451158. doi: 10.1155/2024/3451158. eCollection 2024.
This study is aimed at assessing the prevalence of poor glycemic control using different metrics and its association with in-hospital adverse outcomes. This cross-sectional study was conducted in diabetic patients admitted to a third-level hospital in Colombia between January and July 2022. Poor glycemic control was determined using capillary glucose metrics, including mean glucose values outside the target range, derived time in range (dTIR) (100-180 mg/dL) < 70%, coefficient of variation (CV > 36%), and hypoglycemia (<70 mg/dL). Multiple regression models were adjusted for hospital outcomes based on glycemic control, as well as other sociodemographic and clinical covariates. A total of 330 Hispanic patients were included. A total of 27.6% had mean glucose measurements outside the target range, 33% had a high CV, 64.8% had low dTIR, and 28.8% experienced hypoglycemia. The in-hospital mortality rate was 8.8%. An admission HbA1c level greater than 7% was linked to an increased mortality risk ( = 0.016), as well as a higher average of glucometer readings (186 mg/dL vs. 143 mg/dL; < 0.001). A lower average of dTIR (41.0% vs. 60.0%; < 0.001) was also associated with a higher mortality risk. Glycemic variability was correlated with an increased risk of mortality, hypoglycemia, delirium, and length of hospital stay (LOS). A significant number of hospitalized diabetic patients exhibit poor glycemic control, which has been found to be associated with adverse outcomes, including increased mortality. Metrics like dTIR and glycemic variability should be considered as targets for glycemic control, highlighting the need for enhanced management strategies.
本研究旨在评估使用不同指标评估血糖控制不佳的患病率及其与院内不良结局的关系。这项横断面研究在 2022 年 1 月至 7 月期间在哥伦比亚的一家三级医院收治的糖尿病患者中进行。血糖控制不佳通过毛细血管葡萄糖指标确定，包括目标范围内的平均血糖值之外、时间在目标范围内（dTIR）（100-180mg/dL）<70%、变异系数（CV>36%）和低血糖症（<70mg/dL）。根据血糖控制以及其他社会人口统计学和临床协变量，对医院结局进行了多回归模型调整。共纳入 330 例西班牙裔患者。总共有 27.6%的患者平均血糖测量值超出目标范围，33%的患者 CV 较高，64.8%的患者 dTIR 较低，28.8%的患者出现低血糖症。院内死亡率为 8.8%。入院时 HbA1c 水平大于 7%与死亡率增加相关（ = 0.016），以及血糖仪读数的平均值更高（186mg/dL 与 143mg/dL； < 0.001）。dTIR 的平均值较低（41.0%与 60.0%； < 0.001）也与更高的死亡率相关。血糖变异性与死亡率、低血糖症、谵妄和住院时间（LOS）增加相关。大量住院的糖尿病患者血糖控制不佳，这与不良结局相关，包括死亡率增加。dTIR 和血糖变异性等指标应被视为血糖控制的目标，这突显了需要加强管理策略。
