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首页> 美国卫生研究院文献>International Journal of Environmental Research and Public Health >Stress-Induced Hyperglycemia in Diabetes: A Cross-Sectional Analysis to Explore the Definition Based on the Trauma Registry Data
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Stress-Induced Hyperglycemia in Diabetes: A Cross-Sectional Analysis to Explore the Definition Based on the Trauma Registry Data

机译：糖尿病引起的应激性高血糖：基于创伤登记数据的横断面分析探讨定义

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Background: The diagnosis of diabetic hyperglycemia (DH) does not preclude a diabetes patient from having a stress-induced hyperglycemic response. This study aimed to define the optimal level of elevated glucose concentration for determining the occurrence of stress-induced hyperglycemia (SIH) in patients with diabetes. Methods: This retrospective study reviewed the data of all hospitalized trauma patients, in a Level I trauma center, from 1 January 2009 to 31 December 2016. Only adult patients aged ≥20 years, with available data on serum glucose and glycated hemoglobin A1c (HbA1c) levels upon admission, were included in the study. Long-term average glucose levels, as A1c-derived average glucose (ADAG), using the equation, ADAG = ((28.7 × HbA1c) − 46.7), were calculated. Patients with high glucose levels were divided into three SIH groups with diabetes mellitus (DM), based on the following definitions: (1) same glycemic gap from ADAG; (2) same percentage of elevated glucose of ADAG, from which percentage could also be reflected by the stress hyperglycemia ratio (SHR), calculated as the admission glucose level divided by ADAG; or (3) same percentage of elevated glucose as patients with a defined SIH level, in trauma patients with and without diabetes. Patients with incomplete registered data were excluded. The primary hypothesis of this study was that SIH in patients with diabetes would present worse mortality outcomes than in those without. Detailed data of SIH in patients with diabetes were retrieved from the Trauma Registry System. Results: Among the 546 patients with DH, 332 (32.0%), 188 (18.1%), and 106 (10.2%) were assigned as diabetes patients with SIH, based on defined glucose levels, set at 250 mg/dL, 300 mg/dL, and 350 mg/dL, respectively. In patients with defined cut-off glucose levels of 250 mg/dL and 300 mg/dL, SIH was associated with a 3.5-fold (95% confidence interval (CI) 1.61–7.46; p = 0.001) and 3-fold (95% CI 1.11–8.03; p = 0.030) higher odds of mortality, adjusted by sex, age, pre-existing comorbidities, and injury severity score, than the 491 patients with diabetic normoglycemia (DN). However, in patients with a defined cut-off glucose level of 350 mg/dL, adjusted mortality in SIH in DM was insignificantly different than that in DM. According to the receiver operating characteristic (ROC) curve analysis, a blood sugar of 233 mg/dL, a glycemic gap of 79 (i.e., blood sugar of 251 mg/dL), and a SHR of 1.45 (i.e., blood sugar of 250 mg/dL) were identified as cut-offs for mortality outcomes, with AUCs of 0.622, 0.653, and 0.658, respectively. Conclusions: In this study, a cut-off glucose level of 250 mg/dL was selected to provide a better definition of SIH in DM than glucose levels of 300 mg/dL or 350 mg/dL.
机译：背景：糖尿病性高血糖症（DH）的诊断并不排除糖尿病患者因压力引起的高血糖反应。这项研究的目的是确定升高的葡萄糖浓度的最佳水平，以确定糖尿病患者中压力诱发的高血糖症（SIH）的发生。方法：这项回顾性研究回顾了2009年1月1日至2016年12月31日在I级创伤中心住院的所有创伤患者的数据。仅年龄≥20岁的成年患者，并提供了有关血糖和糖化血红蛋白A1c（HbA1c ）水平被纳入研究。使用公式ADAG =（（28.7×HbA1c）-46.7），计算出长期平均葡萄糖水平，作为A1c衍生的平均葡萄糖（ADAG）。根据以下定义，将高血糖水平的患者分为三个SIH糖尿病（DM）组：（1）ADAG血糖水平相同； （2）ADAG血糖升高的百分比相同，该百分比也可以由应激性高血糖比（SHR）反映出来，计算方法为入院血糖水平除以ADAG；或（3）在患有或未患有糖尿病的创伤患者中，血糖升高的百分比与具有确定的SIH水平的患者相同。登记数据不完整的患者被排除在外。这项研究的主要假设是，与没有糖尿病的患者相比，糖尿病患者的SIH死亡率更高。糖尿病患者SIH的详细数据可从创伤登记系统中获取。结果：在546名DH患者中，根据定义的血糖水平（分别为250 mg / dL，300 mg和300 mg），将332名（32.0％），188名（18.1％）和106名（10.2％）分配为SIH糖尿病患者。 / dL和350 mg / dL。在定义的临界血糖水平为250 mg / dL和300 mg / dL的患者中，SIH分别为3.5倍（95％置信区间（CI）1.61-7.46； p = 0.001）和3倍（95） ％CI 1.11–8.03； p = 0.030）（按性别，年龄，既往合并症和损伤严重程度评分进行调整），死亡率高于491名糖尿病常血糖（DN）患者。然而，在定义的截止血糖水平为350 mg / dL的患者中，DM的SIH调整后死亡率与DM相比无显着差异。根据接收器工作特性（ROC）曲线分析，血糖为233 mg / dL，血糖间隙为79（即251 mg / dL血糖），SHR为1.45（即250血糖） mg / dL）被确定为死亡率的临界值，其AUC分别为0.622、0.653和0.658。结论：在这项研究中，选择的临界血糖水平为250 mg / dL，以提供比DM血糖水平300 mg / dL或350 mg / dL更好的DM SIH定义。

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