Unrecognised diabetes among hospitalized patients
Unrecognised diabetes among hospitalized patients
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DOI：
10.2337/diacare.21.2.246
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发表时间：
1998-02-01
期刊：
影响因子：
16.2
通讯作者：
Ratner, RE
中科院分区：
文献类型：
--
作者：
Levetan, CS;Passaro, M;Ratner, RE
目的-评估医院护理提供给高血糖的个人谁没有一个糖尿病的诊断之前account.Research设计和方法-共1,034连续住院成人患者在一个750张病床的内城教学医院进行了评估。每天通过实验室数据系统识别一个或多个血糖值>200 mg/dl的患者。对入院时未诊断为糖尿病的患者进行评估，以确定医生是否以及如何处理高血糖症，入院时是否进行了新的糖尿病诊断，以及是否计划进行随访以处理高血糖症。37.5%的高血糖内科患者和33%的高血糖外科患者在入院时未诊断为糖尿病。这些患者的平均峰值葡萄糖为299 mg/dl，66%的患者在住院期间有两个或更多的升高值。54%的患者接受了胰岛素治疗，59%的患者接受了床边血糖监测，但66%的患者的每日病情进展记录未能说明高血糖或糖尿病的存在。糖尿病被记录在只有三名患者（7.3%）作为一个可能的诊断在日常progress notes.CONCLUSIONS -尽管显着的高血糖症，大多数医疗记录没有提到未被识别的糖尿病的可能性。由于2型糖尿病的发病和诊断之间平均延迟十年，对高血糖住院患者的进一步评估可能为早期检测和开始治疗提供重要机会。
OBJECTIVE - To evaluate the hospital care rendered to hyperglycemic individuals who did not have a diagnosis of diabetes before admission.RESEARCH DESIGN AND METHODS - A total of 1,034 consecutively hospitalized adult patients at a 750-bed inner-city teaching hospital were evaluated. Patients with one or more plasma glucose values >200 mg/dl were identified by the laboratory data system on a daily basis. Patients without a diagnosis of diabetes at the time of admission were evaluated to determine if and how physicians addressed the hyperglycemia, whether a new diagnosis of diabetes was made during admission, and whether follow-up was planned to address the hyperglycemia.RESULTS - After excluding patients who were admitted for a primary diagnosis of diabetes, 37.5% of all hyperglycemic medical patients and 33% of hyperglycemic surgical patients were without a diagnosis of diabetes at the time of admission. These patients had a mean peak glucose of 299 mg/dl, and 66% had two or more elevated values during their hospitalization. Fifty-four percent received insulin therapy and 59% received bedside glucose monitoring, yet 66% of daily patient progress notes failed to comment on the presence of hyperglycemia or diabetes. Diabetes was documented in only three patients (7.3%) as a possible diagnosis in the daily progress notes.CONCLUSIONS - Despite marked hyperglycemia, most medical records made no reference to the possibility of unrecognized diabetes. Given the average delay of a decade between the onset and diagnosis of type 2 diabetes, further evaluation of hyperglycemic hospitalized patients may present an important opportunity for earlier detection and the initiation of therapy.