Öz
Objectives: Hyperglycemia affects mortality and morbidity in hospitalized patients. About half of the cases represent a newonset of hyperglysemia, the aim was to determine the frequency of hyperglycemia in hospitalized patients on the first and last days of their hospital stay and to determine the relationship of hyperglycemia with the length of hospital stay.Patients and Methods: One thousand nine hundred and seventy one patients hospitalized at Marmara University Hospital for longer than 24 hours between February and July 2007 were included. Capillary blood glucose (BG) was measured by glucometers on the first and last days of hospitalizations. If fasting blood glucose levels measured by glucometer were above 126 mg/dL or random blood glucose levels were above 200 mg/dL, then blood samples were taken from the forearm and blood glucose levels were measured in the laboratory. The history of diabetes and the length of hospital stay of patients were recorded.Results: Patients with a diagnosis of diabetes (Group 1) were 23.8% and the new-onset diabetes (Group 2) patients were 12.3% of the total. The frequency of Group 1 patients was highest (80%) for those in the Coronary Care Unit, and lowest (% 5.8) in the Neurosurgery Clinic. The frequency of Group 2 patients was highest (%25) in the Eye Diseases Clinic and lowest (%2.7) in the Physical Therapy and Rehabilitation Clinic. BG on the first and last days of the hospital stay at the surgery clinics respectively were 157.6 ± 49.0 vs 151.0 ± 60.0 (p>0.05) for the diabetic patients, and were 114.4 ± 37.7 vs 111.8 ± 26.6 (p>0.05) for non-diabetic patients. BG on the first and last days of the hospital stay at the nonsurgery clinics respectively was 173.9 ± 89.5 vs 155.6 ± 43.4 (p>0.05) for diabetic patients and were 110.7 ± 38.3 vs 111.9 ± 28.0 (p>0.05) for nondiabetic patients. The length of the hospital stay for Group 1 was longer than for Group 2 (p<0.05). Conclusion: Among these patients the frequency of diabetes was 36.1%. That is about one third of these patients had new-onset diabetes. The duration of the hospital stay was longer in diabetics
Anahtar Kelimeler
Hyperglycemia Diabetes mellitus New-onset diabetes mellitus Hospital Inpatient
Kaynakça
- 1. Kitabchi AE, Freire AX, Umpierrez GE. Evidence for strict inpatient blood glucose control: time to revise glycemic goals in hospitalized patients.Metabolism 2008;57:116-20. doi:10.1016/j. metabol.2007.08.014
- 2. Umpierrez GE, Isaacs SD, Bazargan N, et al.. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002;87: 978-82. doi: 10.1210/jc.87.3.978
- 3. Zerr KJ, Furnary AP, Grunkemeier GL, et al. . Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 1997; 63:356-61. doi 10.1016/S0003-4975 (96)01044-2
- 4. Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care 1999;22: 1408-14. doi 10.2337diacare.22.9.1408
- 5. Inzucchi SE. Clinical practice. Management of hyperglycemia in the hospital setting. N Eng J Med 2006;355:1903-11. doi: 10.1056/ NEJMcp060094
- 6. Malmberg K, Norhammar A, Wedel H, Rydén L. Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation 1999;99:2626-32. doi: 10.1161/01.CIR.99.20.2626
- 7. Magee MF. Insulin therapy for intensive glysemic control in hospital patients. Hospital Physician 2006;38:17-27.
- 8. Clement S, Braithwaite SS, Magee MF, et al. American Diabetes Association Diabetes in Hospitals Writing Committee Management of diabetes and hyperglycemia in hospitals. Diabetes Care 2004;27:553- 91. doi: 10.2337/diacare.27.2.553
- 9. Levetan C S, Passaro M, Jablonski K, et al. Unrecognized diabetes among hospitalized patients. Diabetes Care 1998;21: 246-9. doi:10.2337/diacare.21.2.246
- 10. Capes S E, Hunt D, Malmberg K, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001;32:2426-32. doi: 10.1161/hs1001.096194
- 11. Pandit MK, Burke J, Gustafson AB, et al. Drug-induced disorders of glucose tolerance. Ann Intern Med 1993;118:529-39.
- 12. Bjerke H S, Shabot MM. Glucose intolerance in critically ill surgical patients: relationship to total parenteral nutrition and severity of illness. Am Surg 1992;58:728-31.
- 13. Coulston AM. Enteral nutrition in the patient with diabetes mellitus. Curr Opin Clin Nutr Metab Care 2000;3:11-5.
- 14. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Position statement. Diabetes Care 2007;30:S42-7. doi: 10.2337/dc07-S042
- 15. Norhammar A, Tenerz A, Nilsson G, et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 2002;359:2140-4. doi./10.1016/S0140-6736(02)09089
- 16. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001;13:813-20. doi:10.1038/414813a
- 17. Stern MP. Diabetes and cardiovascular disease. The “common soil” hypothesis. Diabetes 1995;44:369-74.
- 18. Emir H, Yazıcı D. Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde opere edilen hastalarda bozulmuş glukoz metabolizması sıklığı. Diyabet, Obezite ve Hipertansiyonda Hemşirelik Forumu. 2009;1:14-20.
- 19. Bolk J, van der Ploeg T, Cornel JH, Arnold AE, Sepers J, Umans VA. Impaired glucose metabolism predicts mortality after a myocardial infarction. Int J Cardiol 2001;79:207-14.doi. 10/016/S0167- 5273(01)00422-3
- 20. Uçucu M, Öner FA, Yurdakul S, Ergüney M. In-hospital mortality in patients with impaired fasting glucose and acute coronary syndromes. Marmara Med J 2010;23:257-62.
- 21. Leite SA, Locatelli SB, Niece SP, Oliveira AR, Tockus D, Tosin T. Impact of hyperglysemia on morbidity and mortality, length of hospitalization and rates of re-hospitalization in a general hospital setting in Brazil. Diabetol Metab Syndr 2010;2:49. doi: 10.1186/1758- 5996-2-49.
Öz
Amaç: Hiperglisemi hastane mortalite ve morbiditesini etkileyen faktörlerden birisidir. Yatan hastaların yaklaşık yarısında hiperglisemi varlığının ilk kez tespit edildiği rapor edilmiştir. Bu çalışmanın amacı, Marmara Üniversitesi Hastanesi’nde yatan hastalarda yattıkları ve taburcu oldukları dönemlerde hiperglisemi sıklığının ve hipergliseminin yatış süresi ile ilişkisinin belirlenmesidir. Hastalar ve Yöntem: Çalışmaya, Şubat-Temmuz 2007 tarihleri arasında Marmara Üniversitesi Hastanesi kliniklerinde 24 saatten uzun sureli yatan 1971 erişkin hasta dahil edilmiştir. Hastaların yattıkları ve taburcu oldukları günlerde kan şekerleri, kapiller kandan glukometre ile ölçülmüştür. Glukometre ile ölçülen açlık kan şekeri 126 mg/dL veya tokluk kan şekeri 200 mg /dLüzerinde bulunan hastaların damarlarından alınan kan örneklerinde kan şekeri ölçümleri laboratuvarda yapılmıştır. Hastaların diyabet öyküleri ve yatış süreleri kaydedilmiştir. Bulgular: Hastaların %23.8’inde bilinen diyabet (Grup 1), % 12.3’ ünde yeni tanılı diyabet (Grup 2) saptanmıştır. Grup 1 en sık Koroner Yoğun Bakım Ünitesi’nde (%80) ve en seyrek Beyin Cerrahisi Servisi’nde (% 5.8) görülürken, Grup 2’nin sıklığı en yüksek Göz Servisi hastalarında (%25), en düşük ise Fizik Tedavi Servisi hastalarındadır (%2.7). Grup 1’de yatış ve çıkış sırasında kan şekeri değerleri sırası ile cerrahi bölümlerde diyabet olan ve olmayanlarda (157.6 ± 49.0 vs 151.0 ± 60.0, p>0.05) (114.4 ± 37.7 vs 111.8 ± 26.6, p>0.05), dahili bölümlerde diyabet olan (173.9 ± 89.5 vs 155.6 ± 43.4, p>0.05) ve olmayanlarda (110.7 ± 38.3 vs 111.9 ± 28.0, p>0.05) olarak bulunmuştur. Diyabetik hastaların yatış süresi (14.1±19 gün) diyabetik olmayanlara (7.5±13 gün) göre daha uzundur (p<0.001). Sonuç: Hastanede yatan hastalarda hiperglisemi sıklığı %36.1 olup, bunların yaklaşık 1/3’ü yeni tanılı diyabettir. Diyabetik hastaların yatış süresi daha uzundur.
Anahtar Kelimeler
Hiperglisemi Diabetes mellitus Yeni tanılı diabetes mellitus Hastane yatışı
Kaynakça
- 1. Kitabchi AE, Freire AX, Umpierrez GE. Evidence for strict inpatient blood glucose control: time to revise glycemic goals in hospitalized patients.Metabolism 2008;57:116-20. doi:10.1016/j. metabol.2007.08.014
- 2. Umpierrez GE, Isaacs SD, Bazargan N, et al.. Hyperglycemia: an independent marker of in-hospital mortality in patients with undiagnosed diabetes. J Clin Endocrinol Metab 2002;87: 978-82. doi: 10.1210/jc.87.3.978
- 3. Zerr KJ, Furnary AP, Grunkemeier GL, et al. . Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg 1997; 63:356-61. doi 10.1016/S0003-4975 (96)01044-2
- 4. Golden SH, Peart-Vigilance C, Kao WH, Brancati FL. Perioperative glycemic control and the risk of infectious complications in a cohort of adults with diabetes. Diabetes Care 1999;22: 1408-14. doi 10.2337diacare.22.9.1408
- 5. Inzucchi SE. Clinical practice. Management of hyperglycemia in the hospital setting. N Eng J Med 2006;355:1903-11. doi: 10.1056/ NEJMcp060094
- 6. Malmberg K, Norhammar A, Wedel H, Rydén L. Glycometabolic state at admission: important risk marker of mortality in conventionally treated patients with diabetes mellitus and acute myocardial infarction: long-term results from the Diabetes and Insulin-Glucose Infusion in Acute Myocardial Infarction (DIGAMI) study. Circulation 1999;99:2626-32. doi: 10.1161/01.CIR.99.20.2626
- 7. Magee MF. Insulin therapy for intensive glysemic control in hospital patients. Hospital Physician 2006;38:17-27.
- 8. Clement S, Braithwaite SS, Magee MF, et al. American Diabetes Association Diabetes in Hospitals Writing Committee Management of diabetes and hyperglycemia in hospitals. Diabetes Care 2004;27:553- 91. doi: 10.2337/diacare.27.2.553
- 9. Levetan C S, Passaro M, Jablonski K, et al. Unrecognized diabetes among hospitalized patients. Diabetes Care 1998;21: 246-9. doi:10.2337/diacare.21.2.246
- 10. Capes S E, Hunt D, Malmberg K, et al. Stress hyperglycemia and prognosis of stroke in nondiabetic and diabetic patients: a systematic overview. Stroke 2001;32:2426-32. doi: 10.1161/hs1001.096194
- 11. Pandit MK, Burke J, Gustafson AB, et al. Drug-induced disorders of glucose tolerance. Ann Intern Med 1993;118:529-39.
- 12. Bjerke H S, Shabot MM. Glucose intolerance in critically ill surgical patients: relationship to total parenteral nutrition and severity of illness. Am Surg 1992;58:728-31.
- 13. Coulston AM. Enteral nutrition in the patient with diabetes mellitus. Curr Opin Clin Nutr Metab Care 2000;3:11-5.
- 14. American Diabetes Association. Diagnosis and Classification of Diabetes Mellitus. Position statement. Diabetes Care 2007;30:S42-7. doi: 10.2337/dc07-S042
- 15. Norhammar A, Tenerz A, Nilsson G, et al. Glucose metabolism in patients with acute myocardial infarction and no previous diagnosis of diabetes mellitus: a prospective study. Lancet 2002;359:2140-4. doi./10.1016/S0140-6736(02)09089
- 16. Brownlee M. Biochemistry and molecular cell biology of diabetic complications. Nature 2001;13:813-20. doi:10.1038/414813a
- 17. Stern MP. Diabetes and cardiovascular disease. The “common soil” hypothesis. Diabetes 1995;44:369-74.
- 18. Emir H, Yazıcı D. Koşuyolu Yüksek İhtisas Eğitim ve Araştırma Hastanesi’nde opere edilen hastalarda bozulmuş glukoz metabolizması sıklığı. Diyabet, Obezite ve Hipertansiyonda Hemşirelik Forumu. 2009;1:14-20.
- 19. Bolk J, van der Ploeg T, Cornel JH, Arnold AE, Sepers J, Umans VA. Impaired glucose metabolism predicts mortality after a myocardial infarction. Int J Cardiol 2001;79:207-14.doi. 10/016/S0167- 5273(01)00422-3
- 20. Uçucu M, Öner FA, Yurdakul S, Ergüney M. In-hospital mortality in patients with impaired fasting glucose and acute coronary syndromes. Marmara Med J 2010;23:257-62.
- 21. Leite SA, Locatelli SB, Niece SP, Oliveira AR, Tockus D, Tosin T. Impact of hyperglysemia on morbidity and mortality, length of hospitalization and rates of re-hospitalization in a general hospital setting in Brazil. Diabetol Metab Syndr 2010;2:49. doi: 10.1186/1758- 5996-2-49.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Makaleler |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Ekim 2015 |
| Yayımlandığı Sayı | Yıl 2013 |