Management of critically ill patients with type 2 diabetes:The need for personalised therapy  

作　　者：Palash Kar Karen L Jones Michael Horowitz Adam M Deane 

机构地区：[1]Discipline of Acute Care Medicine,Level 5,Eleanor Harrald Building,University of Adelaide [2]Intensive Care Unit,Level 4,Emergency Services Building,Royal Adelaide Hospital [3]Centre for Research Excellence,University of Adelaide [4]Discipline of Medicine,Level 6,Eleanor Harrald Building,University of Adelaide

出　　处：《World Journal of Diabetes》2015年第5期693-706,共14页世界糖尿病杂志（英文版）（电子版）

摘　　要：Critical illness in patients with pre-existing diabetes frequently causes deterioration in glycaemic control.Despite the prevalence of diabetes in patients admitted to hospital and intensive care units,the ideal management of hyperglycaemia in these groups is uncertain.There are data that suggest that acute hyperglycaemia in critically ill patients without diabetes is associated with increased mortality and morbidity.Exogenous insulin to keep blood glucose concentrations < 10 mmol/L is accepted as standard of care in this group.However,preliminary data have recently been reported that suggest that chronic hyperglycaemia may result in conditioning,which protects these patients against damage mediated by acute hyperglycaemia.Furthermore,acute glucose-lowering to < 10 mmol/L in patients with diabetes with inadequate glycaemic control prior to their critical illness appears to have the capacity to cause harm.This review focuses on glycaemic control in critically ill patients with type 2 diabetes,the potential for harm from glucose-lowering and the rationale for personalised therapy.Critical illness in patients with pre-existing diabetesfrequently causes deterioration in glycaemic control.Despite the prevalence of diabetes in patients admittedto hospital and intensive care units, the idealmanagement of hyperglycaemia in these groups isuncertain. There are data that suggest that acutehyperglycaemiain critically ill patients without diabetesis associated with increased mortality and morbidity.Exogenous insulin to keep blood glucose concentrations〈 10 mmol/L is accepted as standard of care in thisgroup. However, preliminary data have recently beenreported that suggest that chronic hyperglycaemia mayresult in conditioning, which protects these patientsagainst damage mediated by acute hyperglycaemia.Furthermore, acute glucose-lowering to 〈 10 mmol/Lin patients with diabetes with inadequate glycaemiccontrol prior to their critical illness appears to havethe capacity to cause harm. This review focuses onglycaemic control in critically ill patients with type 2diabetes, the potential for harm from glucose-loweringand the rationale for personalised therapy.

关 键 词：DIABETES Critically ILL INTENSIVE care MANAGEMENT Personalised THERAPY 

分 类 号：R587.1[医药卫生—内分泌]