References

emcardio

Неотложная кардиология и кардиоваскулярные риски

Emergency Cardiology and Cardiovascular Risks journal

2616-633X

Белорусский государственный медицинский университет

emcardio-260

Research Article

Мастер-класс

Master-class

Дисгликемия критических состоянии

Dysglycemia of critical conditions

Исачкина

О. Н.

Isachkina

O. N.

Данилова

Л. И.

Danilova

L. I.

УЗ «10 городская клиническая больница»10th Clinical Hospital

ГУО «Белорусская медицинская академия последипломного образования»Belarusian Medical Academy of Postgraduate Education

2018

13112025

22302311

2025

Исачкина О.Н., Данилова Л.И.

Isachkina O.N., Danilova L.I.

Данная работа распространяется под лицензией Creative Commons Attribution 4.0.

This work is licensed under a Creative Commons Attribution 4.0 License.

https://emcardio.bsmu.by/jour/article/view/260

Дисгликемия (в форме гипер- и гипогликемии, а также - неадекватной вариабельности параметров гликемии) развивается у большинства пациентов в критическом состоянии вне зависимости от наличия в анамнезе верифицированного диагноза сахарного диабета. Нарушения параметров гликемии у таких пациентов ассоциированы с возрастанием смертности и осложнений. Результаты наблюдений последних десятилетий подтверждают, что качественный гликемический контроль улучшает клинические исходы в этой группе пациентов. Многоцентровые исследования не подтвердили преимуществ «жесткого» контроля величин гликемии. И в настоящее время принято общее положение избегать гипергликемии (>10,0 ммоль/л) и тяжелой гипогликемии (<2,2 ммоль/л) у пациентов в критическом состоянии. В обзоре рассматриваются вопросы эпидемиологии, патофизиологии и коррекции дисгликемии у пациентов в критическом состоянии.

Dysglycemia develops in the form of hyperglycemia, hypoglycemia and marked glucose variability in critically ill adults whether they are known to have premorbid diabetes or not. Patients with such glucose dysregulation have increased morbidity and mortality. Substantial data obtained over the past decade provide evidence that quality glucose management in these individuals improves clinical outcomes. Multicentre trials did not confirm the benefits of tight control of blood glucose. The general consensus now is that excessive hyperglycemia (>10 mmol/L) and severe hypoglycemia (<2.2 mmol/L) should be avoided in critically ill adults. This review describes the epidemiology, pathophysiology and management of dysglycemia in critically ill patients.

дисгликемиястрессовая гипергликемиясахарный диабеткритические состояниягликемический контроль

dysglycemiastress hyperglycemiadiabetes mellituscritical illnessglycemic control

References1

Viana M.V., Moraes R.B., Fabbrin A.R., Santos M.F., Gerchman F.Assessment and treatment of hyperglycemia in critically ill patients. Rev Bras Ter Intensiva,2014, vol. 26, № 1, pp. 71–76.

Smith F.G., Sheehy A.M., Vincent J.L., Coursin D.B. Critical illness-induced dysglycemia: diabetes and beyond. Critical Care, 2010, vol.14, № 6, pp. 327–328. doi: 10.1186/cc9266.

Yaroshevich N.A., Danilova L.I., Ruckaya T.A. Osobennosti uglevodnogo I lipidnogo obmena u molody’h jensch’in, perenesshih infarkt miokarda [Features of carbohydrate and lipid metabolism in young women after myocardial infarction]. Recept, 2009, № 5, pp. 97–106. (in Russian).

Luz M. Hyperglycemia in hospital management. Therapeutic Advances in Endocrinology and Metabolism, 2011, vol. 2, № 1, pp. 3–7.

[ Smirnova E.S., Mit’kovskaya N.P., Danilova L.I., Kartun L.V. Krupnoochagovy’y infarkt miokarda i giperglikemiya [Large-focal myocardial infarction and hyperglycemia]. Vesci NAN Belarusi. Ser med navuk, 2017, № 1, pp.30–38. (in Russian).

Pittas A., Siegel R., Lau J. Insulin therapy and in hospital mortality in critically ill patients: systematic review and meta-analysis of randomized controlled trials. JPEN J Parenter Enteral Nutr, 2006, vol. 30, № 2, pp.164–172.

American Diabetes Association. Diabetes Care in the Hospital: Standards of Medical Care in Diabetes-2018, Diabetes Care, 2018, vol. 41, № 1, pp.S144–S151. doi.org/10.2337/dc18-S014.

Kathleen M., Susan S., Preiser J-C. Stress hyperglycemia. Lancet, 2009, vol. 373, № 9677, pp. 1798–1807.

Falciglia M., Freyberg R.W., Almenoff P.L., D’Alessio D.A., Render M.L. Hyperglycemia-related mortality in critically ill patients varies with admission diagno.sis. Crit Care Med, 2009, vol. 37, № 12, pp. 3001–3009. doi: 10.1097/CCM.0b013e3181b083f7.

Kosiborod M., Rathore S.S., Inzucchi S.E., Masoudi F.A., Wang Y., Havranek E.P., Krumholz H.M. Admission glucose and m ortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation, 2005, vol. 111, № 23, pp. 3078-3086.

Egi M., Bellomo R., Stachowski E., French C.J., Hart G.K., Hegarty C., Bailey M. Blood glucose concentration and outcome of critical illness: the impact of diabetes. Critl Care Med, 2008, vol. 36, № 8, pp. 2249-2255. doi: 10.1097/CCM.0b013e318181039a.

Mesotten D., Preiser J.C., Kosiborod M. Glucose management in critically ill adults and children. Lancet Diabetes Endocrinol, 2015, vol. 3, № 9, pp. 723-733. doi: 10.1016/S2213-8587(15)00223-5.

Krinsley J.S., Preiser J.C. Time in blood glucose range 70-140 mg/dL >80 % is strongly associated with increased survival in non-diabetic critically ill adults. Crit Care, 2015, № 19, pp. 179-182. doi: 10.1186/s13054-015-0908-7.

Capes S.E., Hunt D., Malmberg K., Gerstein H.C. Stress hyperglycemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet, 2000, № 55, pp. 773-778.

Luethi N., Cioccari L., Tanaka A., Kar P., Giersch E., Deane A.M., Martensson J., Bellomo R. Glycated hemoglobin A1c levels are not affected by critical illness. Crit Care Med, 2016, vol. 44, № 9, pp. 1692-1694.

Schiffner L. Glucose management in critically ill medical and surgical patients. Dimens Crit Care Nurs, 2014, vol. 33, № 2, pp. 70-77. doi: 10.1097/DCC.0000000000000025.

Ali Abdelhamid Y., Kar P., Finnis M.E., Phillips L.K., Plummer M.P., Shaw J.E., Horowitz M., Deane A.M. Stress hyperglycemia in critically ill patients and the subsequent risk of diabetes: a systematic review and meta-analysis. Crit Care, 2016, № 20, pp. 301-307.

Wallander M., Malmberg K., Norhammar A., Ryden L., Tenerz A. Oral glucose tolerance test: a reliable tool for early detection of glucose abnormalities in patients with acute myocardial infarction in clinical practice. Diabetes Care, 2008, № 31, pp. 36-38.

Ishihara M., Inoue I., Kawagoe T., Shimatani Y., Kurisu S., Hata T., Nakama Y., Kijima Y., Kagawa E. Is admission hyperglycemia in non-diabetic patients with acute myocardial infarction a surrogate for previously undiagnosed abnormal glucose tolerance? Eur Heart J, 2006, № 27, pp. 2413-2419.

Hashimoto K., Ikewaki K., Yagi H., Nagasawa H., Imamoto S., Shibata T., Mochizuki S. Glucose intolerance is common in Japanese patients with acute coronary syndrome who were not previously diagnosed with diabetes. Diabetes Care, 2005, № 28, pp. 1182-1186.

Bartnik M., Ryden L , Ferrari R., Malmberg K., Pyorala K., Simoons M., Standl E., Soler-Soler J., Ohrvik J. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe: the Euro Heart Survey on diabetes and the heart. Eur Heart J, 2004, vol. 25, № 21, pp. 1880-1890.

Preiser J-C., Caroline de Longueville. Could type 2 diabetes be a component of the post-intensive care syndrome? Crit Care, 2017, № 2, pp. 321-326.

Zaccardi F., Dhalwani N.N., Webb D.V., Davies M.J., Khunti K. Global burden of hypoglycaemia-related mortality in 109 countries, from 2000 to 2014: an analysis of death certificates. Diabetologia, 2018, vol. 61, iss. 7, pp. 1592-1602.

Schernthaner G., Schernthaner-Reiter M.H. Diabetes in the older patient: heterogeneity requires individualisation of therapeutic strategies. Diabetologia, 2018, № 61, iss. 7, pp.1503-1516.

Krinsley J., Schultz M., Spronk P., Harmsen R.E., van Braam Houckgeest F., van der Sluijs J.P., Melot C., Preiser J.C. Mild hypoglycemia is independently associated with increased m ortality in the critically ill. Crit Care, 2011, vol. 15, № 4, pp. R173-R177. doi: 10.1186/cc10322.

Egi M., Bellomo R., Stachowski E., French C.J., Hart G.K., Taori G., Hegarty C., Bailey M. Hypoglycemia and outcome in critically ill patients. Mayo Clin Proc, 2010, vol. 85, № 3, pp. 217-224. doi: 10.4065/mcp.2009.0394.

Bagshaw S., Bellomo R., Jacka M., Egi M., Hart G., George C. The impact of early hypoglycemia and blood glucose variability on outcome in critical illness. Crit Care, 2009, vol. 13, № 3, pp. R91-R98. doi: 10.1186/cc7921.

Cryer P.E. Preventing hypoglycemia: what is the appropriate glucose alert value? Diabetologia, 2009, vol. 52, № 1, pp. 35-37. doi: 10.1007/s00125- 008-1205-7.

Arabi Y.M., Tamim H.M., Rishu A.H. Hypoglycemia with intensive insulin therapy in critically ill patients: predisposing factors and association with m ortality. Crit Care Med, 2009, vol. 37, № 9, pp. 2536-2544. doi: 10.1097/CCM.0b013e3181a381ad.

Csajbok E.A., Tamas T. Cerebral cortex: a target and source of insulin? Diabetologia, 2016, vol. 59, №8, pp. 1609-1615.

Honiden S., Inzucchi S.E. Metabolic Management during Critical Illness: Glycemic Control in the ICU. Semin Respir Crit Care Med, 2015, vol. 36, № 6, pp. 859-869. doi: 10.1055/s-0035-1565253.

Van den Berghe G., Wouters P., Weekers F., Verwaest C., Bruyninckx F., Schetz M., Vlasselaers D., Ferdinande P., Lauwers P., Bouillon R. Intensive insulin therapy in critically ill patients. N Engl J Med, 2001, vol. 345, № 19, pp.1359-1367.

Van den Berghe G., Wilmer A., Hermans G., Meersseman W., Wouters P.J., Milants I., Van Wijngaerden E., Bobbaers H., Bouillon R. Intensive insulin therapy in the medical ICU. N Engl J Med, 2006, vol. 354, № 5, pp. 449461.

Preiser J-С., Devos P., Ruiz-Santana S., Melot C., Annane D., Groeneveld J., Iapichino G., Leverve X., Nitenberg G., Singer P., Wernerman J., Joannidis M., Stecher A., Chiolero R. A prospective randomised m ulticentre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study. Intensive Care Med, 2009, vol. 35, № 10, pp. 1738-1748. doi: 10.1007/s00134-009-1585-2.

Brunkhorst F.M., Engel C., Bloos F., Meier-Hellmann A., Ragaller M. Weiler N., Moerer O., Gruendling M., Oppert M., Grond S., Olthoff D., Jaschinski U., John S., Rossaint R., Welte T., Schaefer M., Kern P., Kuhnt E., Kiehntopf M., Hartog C., Natanson C., Loeffler M., Reinhart K. Intensive insulin therapy and pentastarch resuscitation in severe sepsis. N Engl J Med, 2008, vol. 358, № 2, pp. 125-139. doi: 10.1056/NEJMoa070716.

Nice-Sugar Study Investigators, Finfer S., Chittock D.R., Su S.Y., Blair D., Foster D., Dhingra V., Bellomo R., Cook D., Dodek P., Henderson W.R., Hйbert P.C., Heritier S., Heyland D.K., McArthur C., McDonald E., Mitchell I., Myburgh J.A., Norton R., Potter J., Robinson B.G., Ronco J.J. Intensive versus conventional glucose control in critically ill patients. N Engl J Med, 2009, vol. 360, № 13, pp. 1283-1297. doi: 10.1056/NEJMoa0810625.

Mowery N.T., Guillamondegui O.D., Gunter O.L., Diaz J.J.Jr., Collier B.R., Dossett L.A., Dortch M.J., May A.K. Severe hypoglycemia while on intensive insulin therapy is not an independent predictor of death after trauma. J Trauma, 2010, vol. 68, № 2, pp. 342-347. doi: 10.1097/ TA.0b013e3181c825f2.

Kosiborod M., Inzucchi S., Goyal A., Krumholz H.M., Masoudi F.A., Xiao L., Spertus J.A. Relationship between spontaneous and iatrogenic hypoglycemia and mortality in patients hospitalized with acute myocardial infarction. JAMA, 2009, vol. 301, № 15, pp 1556-1564. doi: 10.1001/jama.2009.496.

Egi M., Bellomo R., Stachowski E., French C., Hart G. Variability of blood glucose concentration and short-term m ortality in critically ill patients. Anesthesiology, 2006, vol. 105, № 2, pp. 244-252.

Eslami S., Taherzadeh Z., Schultz M., Abu-Hanna A. Glucose variability measures and their eect on mortality: a systematic review. Intensive Care Med, 2011, vol. 37, № 4, pp. 583-593. doi: 10.1007/s00134-010-2129-5.

Krinsley J. Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit Care Med, 2008, vol. 36, № 11, pp. 3008-3013.

Sechterberger M., Bosman R., Oudemans-van Straaten H., Siegelaar S., Hermanides J., Hoekstra J., De Vries J.H. The effect of diabetes mellitus on the association between measures of glycaemic control and ICU mortality: a retrospective cohort study. Crit Care, 2013, vol. 17, № 2, pp. 52-59. doi: 10.1186/cc12572.

Krinsley J. Glycemic variability and mortality in critically ill patients: the impact of diabetes. J Diabetes Sci Technol, 2009, vol. 3, № 6, pp. 12921301.

Baghurst P., Rodbard D., Cameron F. The minimum frequency of glucose measurements from which glycemic variation can be consistently assessed. J Diabetes Sci Tech, 2010, vol. 4, № 6, pp. 1382-1385.

Finfer S., Wernerman J., Preiser J-C., Cass T., Desaive T., Hovorka R., Joseph J.I., Kosiborod M., Krinsley J., Mackenzie I., Mesotten D., Schultz M.J., Scott M.G., Slingerland R., Van den Berghe G., Van Herpe T. Clinical review: consensus recommendations on measurement of blood glucose and reporting glycemic control in critically ill adults. Crit Care, 2013, vol. 17, № 3, pp. 229-234. doi: 10.1186/cc12537.

Hoang Q., Pisani M., Inzucchi S., Hu B., Honiden S. The prevalence of undiagnosed diabetes mellitus and the association of baseline glycemic control on mortality in the intensive care unit: a prospective observational study. J Crit Care, 2014, vol. 29, № 6, pp. 1052-1056. doi: 10.1016/ j.jcrc.2014.06.007.

Lanspa M., Hirshberg E., Phillips G., Holmen J., Stoddard G., Orme J. Moderate glucose control is associated with increased mortality compared with tight glucose control in critically ill patients without diabetes. Chest, 2013, vol. 143, № 5, pp. 1226-1234. doi: 10.1378/chest.12-2072.

Pasquel F.J., Gomez-Huelgas R., Anzola I., Oyedokun F., Haw J.S., Vellanki P., Peng L., Umpierrez G.E. Predictive Value of Admission Hemoglobin A1c on Inpatient Glycemic Control and Response to Insulin Therapy in Medicine and Surgery Patients With Type 2 Diabetes. Diabetes Care, 2015, vol. 38, № 12, pp. e202-e203. doi: 10.2337/dc15-1835.

Bogun M., Inzucchi. S.E. Inpatient M anagem ent of Diabetes and Hyperglycemia. din Ther, 2013, vol. 35, № 5, pp. 724-732. doi: 10.1016/ j.clinthera.2013.04.008.

Malmberg K., Ryden L , Efendic S., Herlitz J., Nicol P., Waldenstrom A., Wedel H., Welin L. Randomized trial of insulin glucose infusion followed by subcutaneous insulin treatm ent in diabetic patients w ith acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol, 1995, vol. 26, № 1, pp. 57-65.

RitsingerV., Malmberg K., Martensson A., Ryden L , Wedel H., Norhammar A. Intensified insulin-based glycaemic control after myocardial infarction: mortality during 20 year follow-up of the randomised Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI 1) trial. Lancet Diabetes Endocrinol, 2014, vol. 2, № 8, pp. 627-633. doi: 10.1016/S2213-8587(14)70088-9.

Malmberg K., Ryden L., Wedel H., Birkeland K., Bootsma A., Dickstein K., Efendic S., Fisher M., Hamsten A., Herlitz J., Hildebrandt P., MacLeod K., Laakso M., Torp-Pedersen C., Waldensh4 m A. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on m ortality and m orbidity. Eur Heart J 2005, vol. 26, № 7, pp. 650-661.

Cheung N., Wong V., McLean M. The Hyperglycemia: Intensive Insulin Infusion in Infarction (HI-5) study: a randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care, 2006, vol. 29, № 4, pp. 765-770.

De M ulder M., Umans V., Cornel J., van der Zant F.M., Stam F., Oem- rawsingh R.M., Akkerhuis K.M., Boersma E. Intensive glucose regulation in hyperglycemic acute coronary syndrome: results of the randomized BIOMarker study to identify the acute risk of a coronary syndrome-2 (BIOMArCS-2) glucose trial. JAMA Intern Med, 2013, vol. 173, № 20 pp. 1896-1904. doi: 10.1001/jamainternmed.2013.10074.

Constantino S., Ambrosini S., Paneni F. The epigenetic landscape in the cardiovascular complications of diabetes. J Endocrinol Invest 2018, № 5, pp. 1-7. doi: 10.1007/s40618-018-0956-3.

Steinberg G.R. Cellular Energy Sensing and Metabolism-Implications for Treating Diabetes: The 2017 Outstanding Scientific Achievement Award Lecture. Diabetes, 2017, vol. 67, № 2, pp. 169-179. doi: 10.2337/dbi17- 0039.

Reddy M.A., Zhang E., Natarajan R. Epigenetic mechanisms in diabetic complications and metabolic memory. Diabetologia, 2015, vol. 58, № 3, pp. 443-455. doi: 10.1007/s00125-014-3462-y.

Dong C.X. SCP4: a Small Nuclear Phosphatase Having a Big Effect on FoxOs in Gluconeogenesis. Diabetes, 2018, vol. 67, № 1, pp. 23-25.

Van Steen S.C., Woodward M., Chalmers J., Li Q., Marre M., Cooper M.E., Hamet P., Mancia G., Colagiuri S., Williams B., Grobbee D.E., DeVries J.H. Hemoglobin glycation index and risk for diabetes-related complications in the Action in Diabetes and Vascular Disease: Preterax and Diamicron Modified Release Controlled Evaluation (ADVANCE) trial. Diabetologia,2018, vol. 61, № 4, pp. 780-789. doi: 10.1007/s00125-017-4539-1.

Hersh A.M., Hirshberg E.L., Wilson E.L. Orme J.F., Morris A.H., Lanspa M.J. Lower Glucose Target Is Associated with Improved 30-Day Mortality in Cardiac and C ardiothoracic Patients. Chest, 2018, pii: S0012- 3692(18)30646-9. doi: 10.1016/j.chest.2018.04.025.

Rabinovich M., Grahl J., Durr E., Gayed R., Chester K., McFarland R., McLean B. Risk of Hypoglycemia During Insulin Infusion Directed by Paper Protocol Versus Electronic Glycemic Management System in Critically III Patients at a Large Academic Medical Center. J Diabetes Sci Technol, 2018, vol. 12, № 1, pp. 47-52.

Watkinson P.J., Barber V.S., Duncan Young J. et al. Outcome of Critically iII Patients Undergoing Mandatory Insulin Therapy Compared to Usual Care Insulin Therapy: Protocol for a Pilot Randomized Controlled Trial. JMIR Res Protoc, 2018, vol. 7, № 3, pp. e44-48. doi: 10.2196/resprot.5912.

Jamaludin U.K., Suhaimi F., Razak A.N. Md Ralib A., Mat Nor M.B., Pretty C.G., Humaidi L. Performance of Stochastic Targeted Blood Glucose Control Protocol by virtual trials in the Malaysian intensive care unit. Comput Methods Programs Biomed, 2018, № 162, pp. 149-155. doi: 10.1016/j.cmpb.2018.03.001.

Lu M., Zuo Y., Guo J., Wen X., Kang Y. Continuous glucose monitoring system can improve the quality of glucose control and glucose variability compared with point-of-care measurements in critically ill patients: a randomized control trial. Medicine (Baltimore), 2018, vol. 97, № 36, pp. e12138. doi: 10.1097/MD.0000000000012138.

The authors declare that there are no conflicts of interest present.