非内分泌科住院糖尿病患者血糖管理会诊情况研究

Consultations for Blood Glucose Management among Inpatients with Diabetes in Non-endocrinology Department

背景 糖尿病是非内分泌科住院患者中的常见疾病之一,常需要内分泌科医师协助进行血糖管理。目的 调查非内分泌科住院糖尿病患者血糖管理会诊情况,并分析会诊的质量和患者的需求情况。方法 回顾性纳入四川大学华西医院2013-01-01至2019-05-23在非内分泌科住院且邀请内分泌科医师会诊的糖尿病患者,记录并整理患者的请会诊情况和病例资料,并根据药品说明书判断其推荐用药在患者中是否存在禁忌证。结果 2013-01-01至2019-05-23在非内分泌科住院且邀请内分泌科医师会诊的糖尿病患者共145 428人次,其中24 499人次邀请内分泌科医师会诊31 369诊次(0.22诊次/人次),20 486人次进行血糖管理会诊24 343诊次(0.17诊次/人次)。人均请血糖管理会诊诊次最多的3个临床科室分别为神经内科(0.30诊次/人次)、呼吸内科(0.25诊次/人次)、心脏内科(0.18诊次/人次)。血糖管理会诊中有完整建议的会诊18 306诊次(16 269人次),最常见的是建议降糖方案为餐时胰岛素+基础胰岛素的组合方案,占全部完整建议会诊的32.34%(5 921/18 306)。完整建议会诊中1.16%(212/18 306)的建议降糖方案患者存在用药禁忌证。结论 大量非内分泌科住院糖尿病患者需要进行专业血糖管理。内分泌科血糖管理会诊建议总体质量较高,但并未充分满足血糖管理需求。

Background Diabetes is one of the common diseases among inpatients in non-endocrinology department. Patients with diabetes require assistance from endocrinologists in their blood glucose management. Objective To investigate consultation of blood glucose management for inpatients with diabetes in non-endocrinology department and analyze the quality of consultation and the needs of patients. Methods The inpatients with diabetes in non-endocrinology department consulted by the endocrinologists in West China Hospital,Sichuan University from January 1,2013 to May 23,2019 were selected and reviewed. The consultation and medical record information was recorded and organized. The recommended medications for the patients were analyzed to determine the potential contraindications according to drug instructions. Results During the study period,we identified 145 428 inpatients with diabetes in non-endocrinology department,24 499 of them had 31 369 consultations from endocrinologists(0.17 consultations/inpatients),and 20 486 of them had 24 343 consultations for blood glucose management(0.17 consultations/inpatients). The top three departments with the most blood glucose management consultations per patient were neurology(0.30 consultations/inpatients),respiratory medicine(0.25 consultations/inpatients),and cardiology(0.18 consultations/inpatients). There were 18 306 blood glucose management consultations(16 269 inpatients) with complete suggestions,and the most commonly recommended hypoglycemic regimen was the combination of insulin with a meal and basal insulin,accounting for 32.34%(5 921/18 306). Among the all consultations,1.16%(212/18 306) patients’ hypoglycemic regimens had drug contraindications. Conclusion A large number of inpatients with diabetes in non-endocrinology department need specialized blood glucose management. The overall quality of the consultation for blood glucose management is relatively high but far from meeting the management requirements.