Queale W S, Seidler A J, Brancati F L
Department of Medicine, Johns Hopkins Medical Institutions, Baltimore, Md, USA.
Arch Intern Med. 1997 Mar 10;157(5):545-52.
To identify predictors of hypoglycemic and hyperglycemic episodes in hospitalized patients with diabetes with special attention to the effectiveness of sliding scale insulin regimens.
Prospective cohort study.
Urban university hospital.
One hundred seventy-one adults with diabetes mellitus as a comorbid condition admitted consecutively to medical inpatient services during a 7-week period.
Demographic, clinical, and laboratory data from inpatient medical records.
Rates of hypoglycemic (capillary blood glucose, < or = 3.3 mmol/L [< or = 60 mg/dL]) and hyperglycemic (capillary blood glucose, > or = 16.5 mmol/L [> or = 300 mg/ dL]) episodes.
Of the patients, 23% experienced hypoglycemic episodes, and 40% experienced hyperglycemic episodes. The overall rates of hypoglycemic and hyperglycemic episodes were 3.4 and 9.8 per 100 capillary blood glucose measurements, respectively. Independent predictors of hypoglycemic episodes included African American race (relative risk [RR], 2.13) and low serum albumin level (RR, 1.92 per 100-g/L decrease); corticosteroid use was associated with a reduced risk of hypoglycemic episodes (RR, 0.32; P < .05). Independent predictors of hyperglycemic episodes included female gender (RR, 1.67), severity of illness (RR, 1.22 per 10 Acute Physiology and Chronic Health Evaluation III units), severe diabetic complications (RR, 2.32), high admission glucose level (RR, 1.33 per 5.5 mmol/L), admission for infectious disease (RR, 2.14), and corticosteroid use (RR, 3.74; P < .05). Of 171 patients, 130 (76%) were placed on a sliding scale insulin regimen. When used alone, sliding scale insulin regimens were associated with a 3-fold higher risk of hyperglycemic episodes compared with individuals following no pharmacologic regimen (RRs, 2.85 and 3.25, respectively; P < .05).
Suboptimal glycemic control is common in medical inpatients with diabetes mellitus. The risk of suboptimal control is associated with selected demographic and clinical characteristics, which can be ascertained at hospital admission. Although sliding scale insulin regimens are prescribed for the majority of inpatients with diabetes, they appear to provide no benefit; in fact, when used without a standing dose of intermediate-acting insulin, they are associated with an increased rate of hyperglycemic episodes.
确定住院糖尿病患者低血糖和高血糖发作的预测因素，并特别关注胰岛素滑动剂量方案的有效性。
前瞻性队列研究。
城市大学医院。
171名患有糖尿病合并症的成年人，在7周期间连续入住内科住院病房。
从住院病历中获取的人口统计学、临床和实验室数据。
低血糖（毛细血管血糖，≤3.3 mmol/L[≤60 mg/dL]）和高血糖（毛细血管血糖，≥16.5 mmol/L[≥300 mg/dL]）发作的发生率。
患者中，23%经历过低血糖发作，40%经历过高血糖发作。低血糖和高血糖发作的总体发生率分别为每100次毛细血管血糖测量3.4次和9.8次。低血糖发作的独立预测因素包括非裔美国人种族（相对风险[RR]，2.13）和低血清白蛋白水平（RR，每降低100 g/L为1.92）；使用皮质类固醇与低血糖发作风险降低相关（RR，0.32；P<.05）。高血糖发作的独立预测因素包括女性性别（RR，1.67）、疾病严重程度（RR，每增加10个急性生理学与慢性健康状况评价III单位为1.22）、严重糖尿病并发症（RR，2.32）、入院时高血糖水平（RR，每增加5.5 mmol/L为1.33）、因传染病入院（RR，2.14）和使用皮质类固醇（RR，3.74；P<.05）。171名患者中，130名（76%）采用了胰岛素滑动剂量方案。单独使用时，胰岛素滑动剂量方案与未采用任何药物治疗方案的个体相比，高血糖发作风险高3倍（RR分别为2.85和3.25；P<.05）。
糖尿病内科住院患者血糖控制不佳很常见。控制不佳的风险与特定的人口统计学和临床特征相关，这些特征可在入院时确定。尽管大多数糖尿病住院患者都采用了胰岛素滑动剂量方案，但它们似乎并无益处；事实上，在没有中效胰岛素常规剂量的情况下使用时，它们与高血糖发作率增加相关。
