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院外糖尿病患者的血糖管理新指南

高血糖症、或具有高水平的血糖,是住院病人的一种常见的、严重的并且昂贵的医疗问题。今天,内分泌协会发布了一个临床实践指南,对达到安全的血糖目标以及操作提供了建议,并且描述了非重症监护患者达到血糖目标所需的草案和方法改善。

高血糖与健康相关并发症和死亡率的增加有关,并能在非糖尿病住院病人中被发现。观察研究报告中呈现高血糖发生在32 ~ 38%的社区医院病人中。控制血糖导致降低医院内科治疗和外科手术病人住院并发症的发生率。新的指南显示所有的病人,不依赖于以前被诊断为糖尿病,在进入医院时应测血糖水平。

“高血糖与住院日延长有关,增加了非重症监护住院病人感染和死亡的发生率。”起草CPG的特别小组主席,亚特兰大艾茉利大学的Guillermo Umpierrez博士说。“这项新的指南包含该领域的专家们一致推荐的管理非重症监护住院病人血糖的建议。”

协会指南具体的建议包括:

·对大多数非严重疾病住院患者血糖目标值应包括:每餐后的葡萄糖低于140毫克/分升和随机血糖小于180毫克/分升。
·所有在家注射胰岛素的糖尿病患者应该在医院得到一个制定好的皮下注射胰岛素方案;
·所有接受手术1型糖尿病和大部分2型糖尿病患者应该接受静脉内(IV)持续胰岛素输注或基础胰岛素联合所需要的速效胰岛素皮下注射来预防围手术期高血糖;
·床旁葡萄糖测试应该在所有入院时血糖值高的患者中,以及通过静脉输注或喂食管接受营养的有或没有糖尿病史的患者中启动。所有1型和2型糖尿病患者应该在停止静脉连续输注胰岛素前至少1-2个小时过渡到按时间规定的皮下胰岛素注射。
 

原文:

Hyperglycemia, or having high glucose levels in the blood, is a common, serious and costly health care problem in hospitalized patients. Today, The Endocrine Society released a clinical practice guideline (CPG) providing recommendations for practical and safe glycemic targets and describing protocols and system improvements required to achieve glycemic goals for hospitalized patients in a non-critical care setting.

Hyperglycemia is associated with increased risk of health complications and mortality, and can be found even in non-diabetic hospitalized patients. Observational studies report that hyperglycemia is present in 32 to 38 percent of patients in community hospitals. Improvement in glycemic control results in lower rates of hospital complications in general medicine and surgery patients. The new CPG suggests that all patients, independent of a prior diagnosis of diabetes, have their blood glucose levels tested upon admission to a hospital.

"Hyperglycemia is associated with prolonged hospital stay, increased incidence of infections and death in non-critically ill hospitalized patients," said Guillermo Umpierrez, MD, of Emory University in Atlanta, Ga. and chair of the task force that authored the CPG. "This new guideline contains consensus recommendations from experts in the field for the management of hyperglycemia in hospitalized patients in non-critical care settings."

Specific recommendations from the Society's CPG include:
 

  • Glycemic targets should include a pre-meal glucose target of less than 140 mg/dl and a random blood glucose of less than 180 mg/dl for the majority of hospitalized patients with non-critical illness;
  • All patients with diabetes treated with insulin at home should be treated with a scheduled subcutaneous insulin regimen in the hospital;
  • All patients with type 1 diabetes and most patients with type 2 diabetes who undergo surgical procedures should receive either intravenous (IV) continuous insulin infusion or subcutaneous basal insulin with bolus insulin as required to prevent hyperglycemia during the perioperative period;
  • Bedside point-of-care glucose testing should be initiated in all patients with high glucose values on admission and in patients with or without a history of diabetes receiving nutrition either through IV or a feeding tube; and
  • All patients with type 1 and type 2 diabetes should be transitioned to scheduled subcutaneous insulin therapy at least one to two hours before discontinuation of iv continuous insulin infusion.
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