a prospective observational study of the relationship of critical illness associated hyperglycaemia in medical icu patients and subsequent development of type 2 diabetes关系的前瞻性观察性研究的重要疾病相关的医疗icu患者高血糖症和随后的2型糖尿病的发展.pdfVIP

Gornik et al. Critical Care 2010, 14:R130 /content/14/4/R130 R E S E A R C H Open Access Research A prospective observational study of the relationship of critical illness associated hyperglycaemia in medical ICU patients and subsequent development of type 2 diabetes 1 1 2 1 Ivan Gornik* , Ana Vujaklija-Brajković , Ivana Pavlić Renar and Vladimir Gašparović Abstract Introduction: Critical illness is commonly complicated by hyperglycaemia caused by mediators of stress and inflammation. Severity of disease is the main risk factor for development of hyperglycaemia, but not all severely ill develop hyperglycemia and some do even in mild disease. We hypothesised that acute disease only exposes a latent disturbance of glucose metabolism which puts those patients at higher risk for developing diabetes. Methods: Medical patients with no history of impaired glucose metabolism or other endocrine disorder admitted to an intensive care unit between July 1998 and June 2004 were considered for inclusion. Glucose was measured at least two times a day, and patients were divided into the hyperglycaemia group (glucose ≥7.8 mmol/l) and normoglycaemia group. An oral glucose tolerance test was performed within six weeks after discharge to disclose patients with unknown diabetes or pre-diabetes who were excluded. Patients treated with corticosteroids and those terminally ill were also excluded from the follow-up which lasted for a minimum of five years with annual oral glucose tolerance tests. Results: A five-year follow-up was completed for 398 patients in the normoglycaemia group, of which 14 (3.5%) developed type 2 diabetes. In the hyperglycaemia group 193 patients finished follow-up and 33 (17.1%) developed type 2 di