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在住院患者的环境中,食前与食后营养胰岛素的效果
Merit George1, Mihail Zilbermint2, Sam Sokolinsky3
1Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 333, Baltimore, MD 21287, USA.
Diabetes research and clinical practice
|July 17, 2024
概括
在住院患者中,将营养胰岛素从餐前转移到餐后,显著降低了低血糖. 这一变化改善了患者的安全性,而没有增加严重的高血糖症,这表明在住院患者糖尿病管理方面有一个有益的策略.
科学领域:
- 内分泌学 在内分泌学.
- 医院 医院 医疗 医疗 医疗 医疗
- 患者安全 患者安全
背景情况:
- 住院患者经常经历不一致的营养摄入量,影响血糖控制.
- 目前在餐前给营养胰岛素的做法可能会导致低血糖或高血糖.
研究的目的:
- 评估一项全医院政策变化的影响,将营养性胰岛素从餐前转移到餐后.
- 评估这一政策转变与血糖控制和停留时间 (LOS) 的变化之间的关联.
主要方法:
- 在社区医院进行的回顾性研究分析了接受营养胰岛素的成年住院患者.
- 数据收集在三个时期:干预前,干预后和干预后.
- 关键结局包括低血糖率 (≤70 mg/dL),严重的低血糖率 (≤40 mg/dL),严重的高血糖率 (≥300 mg/dL),每日平均葡萄糖和LOS.
主要成果:
- 多变量分析显示,随着时间的推移,任何低血糖症 (p=0.001) 和严重低血糖症 (p=0.009) 的风险显著降低.
- 每日平均葡萄糖水平略有但显著增加 (p=0.003).
- 在严重高血糖率 (p=0.10) 或停留时间 (p=0.74) 中没有发现显著差异.
结论:
- 实行食后营养胰岛素的使用显著降低了住院患者的低血糖症.
- 这一策略改善了患者的安全性,降低了低血糖症的风险,而不会增加严重的高血糖症.
- 建议进一步进行前性随机对照试验,以验证这些发现.
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