住院患者血糖管理变迁

目的：对比分析一家三甲医院相隔5年的住院高血糖会诊数据,比较住院高血糖患者分布及血糖管理的变迁。方法：统计并分析内分泌住院总医师在2013年9月1日至2014年6月30日会诊患者的临床资料,并与2008年9月1日至2009年6月30日的会诊资料进行对比。结果：2013年9月1日至2014年6月30日共1463名患者因高血糖会诊,同比增长71.11%。会诊频率高的科室依次为神经内科、心内科、皮肤科及外科等。胰岛素仍是主要的治疗措施。采用分层血糖控制目标,90.8%患者采用宽松标准,8.2%患者采用一般标准。结论：住院高血糖患者数目普遍增长,住院血糖管理是临床工作中的重要部分。分层管理住院高血糖患者的血糖是安全可行的。     

住院患者血糖管理变迁

目的:对比分析一家三甲医院相隔5年的住院高血糖会诊数据,比较住院高血糖患者分布及血糖管理的变迁。方法:统计并分析内分泌住院总医师在2013年~2014年会诊患者的临床资料,并与2008年9月1日~2009年6月30日的会诊资料进行对比。结果:2013年~2014年共1463名患者因高血糖会诊,同比增长71.11%。会诊频率高的科室依次为神经内科、心内科、皮肤科及外科等。胰岛素仍是主要的治疗措施。采用分层血糖控制目标,90.8%患者采用宽松标准,8.2%患者采用一般标准。结论:住院高血糖患者数量普遍增长,住院血糖管理是临床工作中的重要部分。分层管理住院高血糖患者的血糖是安全可行的。     

住院患者的一体化血糖管理方案

高血糖在住院患者中是较为常见的现象,并已被证实能引起更高的死亡率和更多的并发症,有效的血糖管理可以使之得以改善。人们努力寻找安全有效的血糖管理方案,但一直未能在控制高血糖和减少低血糖中寻找到一个理想的平衡点。住院患者一体化血糖管理方案,有助于医务人员对高血糖患者及时发现、科学监护、规范治疗、协作管理并不断总结进步,逐渐减少高血糖或低血糖对住院患者的威胁。     

《中国成人住院患者高血糖管理目标》专家共识解读

住院患者中高血糖可增加其并发症的发生率、病死率及医疗费用开支,并延长住院时间。为安全、有效地控制住院患者的高血糖,中华医学会内分泌学分会组织相关专家制定了关于中国成人住院患者高血糖管理的共识原则：强调个体化原则,根据不同患者和不同病情制定分层血糖控制目标;糖尿病患者住院期间血糖不一定要求达标;一般不应该快速降糖;降糖治疗应尽量避免低血糖及超重和肥胖者体重增加;避免宽松血糖管理增加感染和高血糖危象的风险。     

住院患者血糖控制该如何

血糖控制仅仅是四个字,但这四个字却是糖尿病患者一生的紧箍咒,是松是紧都不好,唯有合适才能让患者舒适。才能确保患者的健康。住院的患者也不例外,需要面对血糖控制这个紧箍咒。     

脑出血微创术患者血糖管理体会

探讨脑出血微创术后合并应激性高血糖患者的影响。内科危重症患者即使无糖尿病史,在应激情况下常出现高血糖,易引起严重感染、多发性神经病变、心肌梗死和多脏器功能衰竭等。因此,积极管理脑出血危重症患者合并的应激性高血糖有利于减少并发症的发生。本文总结2006年5月至2013年5月本院治疗的102例脑出血行微创术患者的血糖管理体会。     

住院患者高血糖的管理

患者在住院期间出现的应激高血糖应该得到充分重视和有效管理。以高血糖为主的代谢紊乱,大大增加了手术危险及术后伤口不愈合、感染等的发生率。严格控制住院患者的高血糖是保障手术成功及减少术后并发症的关键。本文综述了国内外住院患者血糖控制现状、管理策略及安全有效的治疗措施,以探讨患者住院期间的最佳血糖控制策略及药物选择。     

濒危患者血糖变化及临床分析

选自入住监护病房的濒危患者共152名，其中27例为糖尿病患者，125例为非糖尿病患者，观察患者血糖变化及是否与肝肾功能受损、上消化道出血、激素应用有关，及其临床转归。结果：非糖尿病濒危患者血糖升高率为64％，血糖升高与肝。肾功能受损相关，与激素应用及上消化道出血无关。血糖升高组未愈及死亡率上升。结论：濒危患者易导致继发性糖尿病，且高血糖与肝肾功能受损有关，并导致患者不良转归，在重症患者治疗上应严格控制血糖。     

濒危患者血糖变化及临床分析

选自入住监护病房的濒危患者共152名,其中27例为糖尿病患者,125例为非糖尿病患者,观察患者血糖变化及是否与肝肾功能受损、上消化道出血、激素应用有关,及其临床转归.结果非糖尿病濒危患者血糖升高率为64%,血糖升高与肝肾功能受损相关,与激素应用及上消化道出血无关.血糖升高组未愈及死亡率上升.结论濒危患者易导致继发性糖尿病,且高血糖与肝肾功能受损有关,并导致患者不良转归,在重症患者治疗上应严格控制血糖.     

如何对住院患者实施安全平稳的血糖管理

目前中国成人糖尿病的患病率估计为11.6％,即全国约有1.139亿成年糖尿病患者［1］。对住院患者实施安全平稳的血糖管理是临床需要解决的重要问题。分析1993年至2012年解放军总医院所有科室住院患者的病例资料,发现住院患者中2型糖尿病（ T2DM）患者的比例由4.55％逐年上升至11.97％,全院死亡患者中 T2 DM 患者的构成比由9.64％逐年升至25.47％［2］。本世纪初的住院患者血糖管理中,重点关注降低高血糖,倾向于较低的血糖控制目标,而这种治疗模式导致低血糖的风险明显增加。2007年之后的一系列大型研究和Meta分析表明：低血糖会抵消血糖控制带来的益处。因此,近年来住院血糖管理的原则强调的是：安全平稳地控制血糖。但目前临床上还存在很多血糖管理的障碍,尤其是对正确的胰岛素治疗方案的认识不足［3］,本文将从血糖波动的危害、血糖控制目标的演变及最佳治疗等方面,阐述住院患者血糖管理中亟需重视的问题。     

Sugar and Stroke: Cerebrovascular Disease and Blood Glucose Control

In this review we will discuss the cerebrovascular consequences of dysglycemia and current evidence for therapy, making reference to recent work in the fields of neuropathology, epidemiology, and relevant clinical trial data. Prospective observational and clinical trial data show a clear association between diabetes mellitus and vascular disease, which extends to cerebrovascular disease. The benefits of intervention to lower blood glucose in terms of microvascular health are well established but benefit on macrovascular, especially cerebrovascular, health has been less apparent. Recent large‐scale trials and metaanalyses have helped us to better define the role of glycemic control in macrovascular disease. Although few studies of glycemic therapy have used cerebrovascular disease as a primary endpoint, stroke‐specific data can be derived. Associations between blood glucose and outcome are also apparent for acute stroke. A period of hyperglycemia is common, with elevated blood glucose in the periinfarct period consistently linked with poor outcome in patients with and without diabetes. The mechanisms that underlie this deleterious effect of dysglycemia on ischemic neuronal tissue remain to be established, although in vitro research, functional imaging, and animal work have provided clues. While prompt correction of hyperglycemia can be achieved, trials of acute insulin administration in stroke and other critical care populations have been equivocal. Diabetes mellitus and hyperglycemia per se are associated with poor cerebrovascular health, both in terms of stroke risk and outcome thereafter. Interventions to control blood sugar are available but evidence of cerebrovascular efficacy are lacking. In diabetes, glycemic control should be part of a global approach to vascular risk while in acute stroke, theoretical data suggest intervention to lower markedly elevated blood glucose may be of benefit, especially if thrombolysis is administered. Trials have been underpowered to demonstrate treatment effect and any intervention must be balanced against risk of hypoglycemia.     

Automated Inpatient Blood Sampling for Glucose Measurement: Automated Blood Sampling and Glucose Sensing in Critical Care Settings

Background

Tight glycemic control (TGC) studies in intensive care units (ICU) have shown substantial improvements in clinical outcomes. However, implementation of TGC in ICU practice is partly constrained by the lack of automated continuous blood glucose monitoring systems that can facilitate clinically accurate feedback of glycemic data. The aim of this work is to develop a portable automated blood sampling system for integration with a glucose sensor for use in critical care settings.

Methods

Clinical prototypes for glucose sensing in blood were developed based on two distinct technologies: mid-infrared laser absorption spectroscopy and electrochemistry. Concurrently, an automated peripheral venous blood sampling system was developed for integration with the glucose sensing system.

Results

The glucose sensing prototypes were validated clinically with various biological samples in a continuous mode. A customized micropump was employed in conjunction with a novel peripheral venous catheter system to automatically sample blood from the subject''s forearm. Microvolumes of blood were sampled in continuous and intermittent modes at clinically relevant user-defined frequencies. The clinical feasibility of blood sampling, along with continuous glucose sensing, was demonstrated.

Conclusion

Cascade''s automated peripheral venous blood sampling system, in combination with a flow-through glucose sensor system, offers several advantages over current state-of-the-art systems. This includes the potential for significantly improved workflow in the ICU, minimal discomfort to the patient, and accurate glucose measurement in whole blood, thus helping achieve tight glycemic control.     

脑梗死急性期血糖升高对患者疗效的影响

目的探讨脑梗死急性期血糖升高对患者疗效的影响。方法选择玉溪矿业医院2012—2013年收治的首诊脑梗死急性期患者84例,以第1次血糖为准将患者分为高血糖组48例和正常血糖组36例。两组均给予内科对症支持治疗,比较两组患者脑梗死面积、神经功能缺损程度及临床疗效。结果血糖正常组患者脑梗死面积及脑神经功能缺损程度优于高血糖组(P0.05);高血糖组总有效率为66.7%,低于正常血糖组的91.6%(P0.01)。结论脑梗死急性期血糖升高影响患者治疗效果,且患者脑梗死面积大、神经功能缺损程度严重。     

Development of Computer-Based Training to Enhance Resident Physician Management of Inpatient Diabetes

Background

Treating hyperglycemia promotes better outcomes among inpatients. Knowledge deficits about management of inpatient diabetes are prevalent among resident physicians, which may affect the care of a substantial number of these patients.

Methods

A computer-based training (CBT) curriculum on inpatient diabetes and hyperglycemia was developed and implemented for use by resident physicians and focuses on several aspects of the management of inpatient diabetes and hyperglycemia: (1) review of importance of inpatient glucose control, (2) overview of institution-specific data, (3) triaging and initial admission actions for diabetes or hyperglycemia, (4) overview of pharmacologic management, (5) insulin-dosing calculations and ordering simulations, (6) review of existing policies and procedures, and (7) discharge planning. The curriculum was first provided as a series of lectures, then formatted and placed on the institutional intranet as a CBT program.

Results

Residents began using the inpatient CBT in September 2008. By August 2009, a total of 29 residents had participated in CBT: 8 in family medicine, 12 in internal medicine, and 9 in general surgery. Most of the 29 residents confirmed that module content met stated objectives, considered the information valuable to their inpatient practices, and believed that the quality of the online modules met expectations. The majority reported that the modules took just the right amount of time to complete (typically 30 min each).

Conclusions

Improvement in inpatient diabetes care requires continuous educational efforts. The CBT format and curriculum content were well accepted by the resident physicians. Ongoing assessment must determine whether resident practice patterns are influenced by such training.     

Hospital related hyperglycemia as a predictor of mortality in non-diabetes patients: A systematic review

Background and aimsHyperglycemia is a condition often found in hospitalized patients due to stress injury, parenteral nutrition or medications administered during hospitalization. According to previous studies, hyperglycemia could be an independent predictor of mortality. The objective of the study is to assess the risk of mortality in non-diabetic patients with hyperglycemia during hospitalization.MethodsIn this systematic review, we conducted literature reviews on several databases. Twelve studies were retrieved and critically reviewed using NOS.ResultsA majority of the studies reported that hospital related hyperglycemia increased the mortality rate.ConclusionsHospital related hyperglycemia is an independent predictor factor for both in-hospital and long-term mortality.     

Inpatient management of diabetes mellitus

There is now widespread appreciation of the importance of maintaining glucose levels as close to the normal range as possible among outpatients with diabetes. However, the importance of tight glucose control in inpatients is less well established. During the past several years, it has become apparent that hyperglycemia in hospitalized patients, especially those in the postoperative setting, is associated with poorer outcomes. In addition, two randomized trials have shown improved outcomes with intensive glucose management in acutely ill patients. Based on these studies and our own experience, we propose guidelines and a framework for improving the glycemic control of hospitalized patients.