Ruiz-Hernández A, González-Arnaiz E, González-Puente I, Tejada-García J, Beltrán-Rodríguez I, García Tuñón-Villaluenga L A, Pérez-Álvarez A, González-Feito P, Villarrubia-González B, Barrutia-Yovera J, Ballesteros-Pomar M D
Complejo Asistencial Universitario de León, 24001 León, España.
Universidad de León, 24071 León, España.
Rev Neurol. 2024 Oct 16;79(8):209-215. doi: 10.33588/rn.7908.2023337.
To determine the treatment of hyperglycemia in the stroke unit, and to compare the morbidity and mortality of patients treated with an intravenous (iv) insulin therapy protocol compared to subcutaneous (sc) insulin when reaching glycemia levels of = 155 mg/dL.
We performed a prospective observational study of patients admitted to our stroke unit between July and October 2022. Demographic, glycemic and prognostic variables were collected. Glycemic variability was defined as the standard deviation (SD) of the mean individual glycemia during the first 24-72 hours. Acute complications during admission and mortality at discharge and at 3 months were determined. The variables were analysed by subgroup according to the insulin regime in patients with type 2 diabetes mellitus (DM2) or stress hyperglycemia.
The sample consisted of 181 patients, of whom 63.5% were male, with a mean age of 74.2 (SD: 11.6) years. 25.4% required insulin due to glycemia = 155 mg/dL (18 patients iv and 28 sc). 31.5% had DM2 (82.6% of the group receiving insulin and 14% of group without insulin). The group receiving insulin presented higher levels of glycemic variability, at 33.3 (SD: 21.7) mg/dL vs. 11.7 (SD: 7) mg/dL (p < 0.01), more acute complications (43.5% vs. 19.2%; p < 0.01) and higher mortality at 3 months (19.5% vs. 6.6%; p = 0.04) than the group without insulin, and no differences were observed between the type of insulin regime in the subgroups with DM2 or stress hyperglycemia.
The patients with glycemia = 155 mg/dL presented higher levels of glycemic variability, acute complications and mortality at 3 months, and no differences were observed in the type of insulin regime, regardless of whether they had DM2.
确定卒中单元中高血糖的治疗方法，并比较当血糖水平≥155mg/dL时，接受静脉胰岛素治疗方案与皮下胰岛素治疗的患者的发病率和死亡率。
我们对2022年7月至10月间入住我院卒中单元的患者进行了一项前瞻性观察研究。收集了人口统计学、血糖和预后变量。血糖变异性定义为最初24 - 72小时内个体平均血糖的标准差（SD）。确定了入院期间的急性并发症以及出院时和3个月时的死亡率。根据2型糖尿病（DM2）或应激性高血糖患者的胰岛素治疗方案，对变量进行亚组分析。
样本包括181名患者，其中63.5%为男性，平均年龄74.2（标准差：11.6）岁。25.4%的患者因血糖≥155mg/dL需要胰岛素治疗（18例静脉注射胰岛素，28例皮下注射胰岛素）。31.5%的患者患有DM2（接受胰岛素治疗组的82.6%和未接受胰岛素治疗组的14%）。接受胰岛素治疗的组血糖变异性水平更高，分别为33.3（标准差：21.7）mg/dL和11.7（标准差：7）mg/dL（p<0.01），急性并发症更多（43.5%对19.2%；p<0.01），3个月时死亡率更高（19.5%对6.6%；p = 0.04），且在DM2或应激性高血糖亚组中，胰岛素治疗方案类型之间未观察到差异。
血糖≥155mg/dL的患者血糖变异性水平、急性并发症和3个月时的死亡率更高，且无论是否患有DM2，胰岛素治疗方案类型均无差异。
