MA-NVR-2015年-03 住院患者血糖管理-安全平稳降糖.pptVIP

* 除了心血管系统之外，低血糖的危害还囊括了眼睛，脑血管病变、精神负担，肾脏等等其他方面 血糖波动及变异增加低血糖的发生发风险，通过图中色森林图可以看出来，日内血糖波动和日间血糖波动都能增加低血糖的发生风险。 Background: We set out to study the relationship between different measures of glycemic variability and the rate of hypoglycemia in patients with type 2 diabetes. Subjects and Methods: Data were pooled from three 24-week insulin trials including patients on twice-daily (BID) insulin lispro mix 75/25 (75% insulin lispro protamine suspension, 25% insulin lispro) (n = 805), daily (QD) insulin glargine (n = 1,019), insulin lispro protamine suspension (n = 353) (QD or BID), and insulin detemir (n = 166) (QD or BID), all with continuation of prestudy oral antihyperglycemic medications. Glycemic variability measures were derived from seven-point self-monitored blood glucose profiles. Results: At baseline, mean ( ± SD) age was 56.9 ± 9.7 years, duration of type 2 diabetes was 9.5 ± 6.1 years, hemoglobin A1c (HbA1c) was 8.9 ± 1.1%, and 51.9% were male. Intra-day glucose coefficient of variation (CV), fasting blood glucose, intra-day minimum glucose and inter-day glucose CV at 24 weeks, and intra-day glucose CV at baseline were significantly correlated with the rate of hypoglycemia events between Weeks 12 to 24 (P 0.05 for all measures). Conclusions: Intra-day and inter-day glycemic variability is significantly associated with the risk of hypoglycemia in insulintreated patients with type 2 diabetes, even after adjusting for mean glucose and HbA1c. The intra-day glycemic variability before starting insulin is significantly associated with the risk of hypoglycemia during insulin treatment, which points at treatment- and patient-related factors mediating this relationship. * 低血糖和住院患者的死亡率增加相关。来自美国哈佛大学医学院的Rajesh Garg教授及其团队进行了一项研究，该研究为回顾性队列研究，研究资料来自2008年4月1日至2010年11月30日期间住院患者的电子数据库。低血糖定义为即时血糖测试中一次或者多次血糖≤50mg/dl（2.8mmol/L）。该研究结果表明，发生低血糖的患者的死亡率（22.1%）9倍高于未发生低血糖的患者（2.5%）。 * OBJECTIVE：Dysglycemia is associated with poorer prognosis in patients with acute myocardial infarction (AM