老年糖尿病伴食欲不佳患者住院期间的血糖管理

In-hospital management of hyperglycemia in elderly patients with diabetes mellitus and dysorexia

目的探讨老年糖尿病伴食欲不佳患者住院期间血糖管理的优化策略。方法选取89例年龄>65岁、住院前2天内每日摄入主食<25 g、住院≥5 d的患者,采用计算机随机分成血糖管理组(43例)和对照组(46例)。血糖管理组患者由医院血糖管理小组制定个体化血糖控制目标,并实施合理的血糖监测及降糖方案。结果血糖管理组较对照组平均血糖水平[(10.19±1.38)mmol/L比(12.91±1.25)mmol/L,P=0.004]、血糖变异性[(2.91±0.46)mmol/L比(3.34±0.49)mmol/L,P=0.001]及低血糖发生率(1.8%比2.9%,P=0.049)显著降低;住院天数显著缩短(13.63±2.06)d比(14.64±2.43)d,P=0.036);血糖达标率显著增高(65.1%比39.1%,P=0.014)。结论对老年糖尿病伴食欲不佳住院患者,优化血糖管理可获得明显的临床疗效。

Objective To explore the optimal strategy of in hospital glycemic control for elderly patients with diabetes mellitus and dysorexia.Methods Eighty-nine diabetic patients who were older than 65 years and took less than 25 grams for main meal two days prior to admission were randomly allocated into glycemic management group(n=43)and control group(n=46).For patients in the glycemic management group,individual glycemic control target was made by the hospital glycemic management committee,and optimal hypoglycemic protocol was carried out based upon strict glycemic monitoring.Results Patients in the glycemic management group had significantly lower average serum glucose level[(10.19±1.38)mmol/L VS.(12.91±1.25)mmol/L,P=0.004],more decreased glucose variability[(2.91±0.46)mmol/L VS.(3.34±0.49)mmol/L,P=0.001]and less incidence of hypoglycemia(1.8%VS.2.9%,P=0.049)than those in the control group.The time of hospital stay was shorter[(13.63±2.06)d VS.(14.64±2.43)d,P=0.036]and success rate of optimal glycemic control was higher(65.1%VS.39.1%,P=0.014)in the glycemic management group.Conclusion The optimal glycemic management is clinically beneficial for elderly in-hospital patients with diabetes and dysorexia.