2型糖尿病患者个体化院内血糖管理应用.pptVIP

以患者为中心对糖尿病患者 实施全院一体化血糖管理是大势所趋 谢谢！ * 糖尿病在住院患者中普遍存在，研究显示在美国，住院患者中糖尿病的患病率约为12%-25%，中国为15.1%。 在内科和外科住院患者中，38%的患者FBG≥ 7.0mmol/L或随机血糖≥11.1mmol/L，其中，67%已知有糖尿病病史，33%未诊为糖尿病。 * 对2007年9月1日一2012年8月31日入住笔者医院的12176例糖尿病患者资料进行回顾性调查分析。糖尿病并发微血管并发症33．79％，心脑血 管并发症30．5％，急性代谢紊乱11．08％，伴随高血压57．4％，脂代谢紊乱31．6％，感染32．28％、肿瘤5．83％ * 与血糖正常的住院患者相比，伴发高血糖的患者住院结局更差。 本研究目的是确定院内高血糖的患病率及住院患者合并高血糖（无论是否有糖尿病病史）的生存率、住院结局。研究回顾了1998年7月至10月期间乔治亚Baptist医学中心2030名内科及外科的住院患者，其中1886名患者纳入分析。新发生的高血糖定义为入院或住院期间FPG≥126 mg/dl（7 mmol/L），或2次及以上随机血糖≥200 mg/dl（11.1 mmol/L）。住院时，38%的患者伴发高血糖，其中26%已知糖尿病病史，12%无糖尿病病史。 结果显示，与血糖正常的住院患者相比，住院期间新发高血糖的患者的住院时间更长，分别为9.0天和4.5天（P 0.01）。 该研究还提示，1886例住院患者中，高血糖是患者（无论有无糖尿病病史）预后较差及高死亡率的重要指标。 所有住院患者中，高血糖的患者死亡率为16%，正常者的死亡率为1.7%； Admission hyperglycemia has been associatedwith increased hospital mortality in critically ill patients; however, it is not known whether hyperglycemia in patients admitted to general hospital wards is associated with poor outcome. The aim of this study was to determine the prevalence of in-hospital hyperglycemia and determine the survival and functional outcome of patients with hyperglycemia with and without a history of diabetes. We reviewed the medical records of 2030 consecutive adult patients admitted to Georgia Baptist Medical Center, a community teaching hospital in downtown Atlanta, GA, from July 1, 1998, to October 20, 1998. New hyperglycemia was defined as an admission or in-hospital fasting glucose level of 126 mg/dl (7 mmol/Liter) or more or a random blood glucose level of 200 mg/dl (11.1 mmol/Liter) or more on 2 or more determinations. Hyperglycemia was present in 38% of patients admitted to the hospital, of whom 26% had a known history of diabetes, and 12% had no history of diabetes before the admission. Newly discovered hyperglycemia was associated with higher in-hospital mortality rate (16%) compared with those patients with a prior history of diabetes (3%) and subjects with normoglycemia (1.7%; both P 0.01). In addition, new hyperglycemic patients had a