An Update on Measures of Preoperative Glycemic Control.
An Update on Measures of Preoperative Glycemic Control.
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术前血糖控制措施的最新进展。
DOI：
10.1097/gox.0000000000002240
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发表时间：
2019
期刊：
影响因子：
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通讯作者：
Rasko,YvonneM
中科院分区：
文献类型：
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作者：
Ngaage,LedibabariM;Osadebey,EmmanuelN;Tullie,SebastianTE;Elegbede,Adekunle;Rada,ErinM;Spanakis,EliasK;Goldberg,Nelson;Slezak,Sheri;Rasko,YvonneM
血糖控制是手术术前可改变的危险因素。传统上，血红蛋白A1c （HbA1c）和血浆葡萄糖被用作血糖控制的措施。然而，研究表明，关于这些常规措施预测不良手术结果的能力，结果好坏参半。这可以用HbA1c和血清葡萄糖捕获的时间窗来解释：分别是长期和即时血糖控制。果糖胺、糖基化白蛋白和1,5 -无氢葡萄糖醇构成了血糖控制的替代指标，这些指标越来越受到关注，但在外科领域尚未得到充分利用。这些非传统的测量方法反映了血糖在前几天到几周的时间变化。因此，它们可以更准确地反映最显著影响手术结果的时间窗内的血糖控制情况。此外，这些替代措施可预测负面结果，即使在非糖尿病人群和慢性肾脏疾病和贫血患者中，HbA1c表现不佳。采用这些更新的血糖指标可以提高术前评估的价值，从而可以评估任何术前血糖控制干预措施的有效性，并更好地预测与高血糖相关的不良后果。本综述的目的是提供关于术前血糖管理的最新信息，并描述可能提高我们预测和控制与血糖控制不良相关的负面结果的能力的替代指标。
Glycemic control represents a modifiable preoperative risk factor in surgery. Traditionally, hemoglobin A1c (HbA1c) and plasma glucose are utilized as measures of glycemic control. However, studies show mixed results regarding the ability of these conventional measures to predict adverse surgical outcomes. This may be explained by the time window captured by HbA1c and serum glucose: long-term and immediate glycemic control, respectively. Fructosamine, glycosylated albumin, and 1, 5-anhydroglucitol constitute alternative metrics of glycemic control that are of growing interest but are underutilized in the field of surgery. These nontraditional measures reflect the temporal variations in glycemia over the preceding days to weeks. Therefore, they may more accurately reflect glycemic control within the time window that most significantly affects surgical outcomes. Additionally, these alternative measures are predictive of negative outcomes, even in the nondiabetic population and in patients with chronic renal disease and anemia, for whom HbA1c performs poorly. Adopting these newer metrics of glycemia may enhance the value of preoperative evaluation, such that the effectiveness of any preoperative glycemic control interventions can be assessed, and adverse outcomes associated with hyperglycemia better predicted. The goal of this review is to provide an update on the preoperative management of glycemia and to describe alternative metrics that may improve our ability to predict and control for the negative outcomes associated with poor glycemic control.