Hiperglisemi sebebiyle yatan ve intravenöz insülin infüzyonu uygulanan olgularda subkatan tedaviye geçiş protokollerinin karşılaştırılması
Küçük Resim Yok
Dosyalar
Tarih
2021
Yazarlar
Dergi Başlığı
Dergi ISSN
Cilt Başlığı
Yayıncı
Ege Üniversitesi, Tıp Fakültesi
Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Giriş ve Amaç: Yatarak tedavi görmekte olan hastalarda hiperglisemi altta yatan hastalığın şiddetiyle ilişkili olduğu gibi önemli bir morbidite ve mortalite sebebidir. Kan şekeri regülasyonu sağlanmasının mortalite üzerine olumlu etkileri yapılan farklı çalışmalarda gösterilmiştir. Yatan hastalarda hiperglisemi yönetiminde en etkili yöntem intravenöz (IV) insülin uygulamasıdır. Ancak yakın kan şekeri takibi gerektirmesi, hastalarda mobilizasyon kısıtlılığı yaratması gibi nedenler, IV insülin tedavisinin sürekli olarak uygulanmasında zorluk oluşturmaktadır. Güncel kılavuzlarda kan şekeri regülasyonu sağlanmış olan hemodinamik açıdan stabil hastalarda IV insülin tedavisinden subkutan (SC) insülin tedavisine geçiş yapılması önerilmektedir. Biz, kliniğimizde IV tedaviden SC tedaviye geçişte en etkin ve güvenli olarak kullanabilecek doz oranını bulmayı amaçladık. Gereç ve Yöntem: Bu çalışmaya 2021 yılında Ege Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıkları Kliniği’nde yatmakta olan ve hiperglisemi nedeniyle IV insülin tedavisi uygulanan 82 hasta dahil edilmiştir. Hastaların 7’si çeşitli sebeplerden dolayı çalışmadan çıkartılmıştır. Hastaların IV insülin tedavisi altında kan şekerinin hedef aralıkta (110-180 mg/dl) olduğu 6 saatlik süre boyunca almış olduğu insülin miktarı (U) 4 ile çarpılarak günlük total insülin ihtiyacı (GTİİ) hesaplanmıştır. GTİİ farklı oranlarda yeniden hesaplanarak uygulanacak günlük SC insülin dozu belirlenmesi planlamıştır. Bu oranlar %80 (Grup 80), %100 (Grup 100) ve %125 (Grup 125) olacak şekilde üç grup olarak belirlenmiş olup hastaların hangi gruba dahil olacağına bağımsız bir araştırmacı tarafından kura yöntemiyle karar verilmiştir. Tüm hastalara hesaplanan günlük SC insülin dozunun yarısı bazal insülin, diğer yarısı üç öğüne eşit olarak bölünecek şekilde yemek önceleri bolus insülin olarak uygulanmıştır. SC insülin tedavisine geçiş sonrası 48 saat boyunca hastalardan parmak ucu kan glukoz ölçümleri yapılmıştır. Hastaların demografik özellikleri, vücut kitle indeksi, laboratuvar verileri, kaydedilen kan şeker ölçümleri ve ölçüm zamanları tarafımızca kaydedilmiştir. Bulgular: 75 hastadan toplam 1251 kan şekeri ölçümü kaydedilmiştir. Kaydedilen ölçümlerin hedef aralıkta (110-180 mg/dl) olma oranlarının ortalamaları Grup 80, Grup 100 ve Grup 125 için sırasıyla %37,75, %42,65 ve %60,7 olarak izlenmiştir (p<0,0001). Hastaların kan şekerlerinin hedef aralıkta geçirdiği süre karşılaştırıldığında sırasıyla %40,82, %38,12 ve %63,67 olarak izlenmiştir (p<0,0001). Hastaların kan şeker ölçümlerinden hesaplanarak belirlenen hedef aralığın üzerinde geçirdiği zaman (TAR) aralığı, güncel kılavuzlarda önerildiği biçimde ikiye ayrılmıştır. 180-250 mg/dl arası için TAR 1, >250 mg/dl için TAR 2 olarak belirlenmiştir. Buna göre TAR 1 ortalamaları Grup 80, Grup 100 ve Grup 125 için sırasıyla %34,15, %40,16 ve %21,99 (p=0,001); TAR 2 ortalamaları sırasıyla %26,4, %24,68 ve %12,07 olarak izlenmiştir (p=0,05). Hipoglisemi (<70 mg/dl) gelişen hasta sayısı karşılaştırılmıştır. Grup 80’de 3 hastada (%11,5), Grup 100’de 3 hastada (%15), Grup 125’te 7 hastada (%24,1) olmak üzere toplamda 13 hastada hipoglisemi görülmüştür. Yapılan analizlerde üç grup arasındaki farklılık istatiksel olarak anlamlı bulunmamıştır (p=0,44). Sonuç: Yatan hastalarda IV insülin tedavisinden SC tedaviye geçişte %125 protokolünün uygulanması, literatürde yer alan diğer protokollere göre komplikasyon riskini arttırmadan daha etkin kan şekeri regülasyonu sağlamaktadır.
Introduction: Hyperglycemia is a potent predictor of morbidity and mortality, as well as being related to the severity of the underlying disease for hospitalized patients. Favorable effects on mortality of hyprglycemia management has been shown in different studies. The most effective method in the management of hyperglycemia in hospitalized patients is intravenous (IV) insulin administration. However, reasons such as the need for frequent blood glucose monitoring and the limitation of mobilization in patients, make difficulties for administration of IV insulin therapy. The most effective method in the management of hyperglycemia in hospitalized patients is intravenous (IV) insulin administration. Current guidelines recommend switching from IV insulin therapy to subcutaneous (SC) insulin therapy in hemodynamically stable patients with well-regulated blood glucose. We aimed to find the dose rate that can be used most effectively and safely in the transition from IV therapy to SC therapy in our clinic. Methods: In this study, 82 patients who were hospitalized in Ege University Medical Faculty Hospital Internal Medicine Clinic in 2021 and treated with IV insulin due to hyperglycemia were included. 7 of these patients were excluded from the study for various reasons. Total daily insulin (TDI) was calculated by multiplying the insulin amount (U) taken by the patients during the 6-hour period when the blood sugar was in the target range (110-180 mg/dl) under IV insulin therapy. The daily SC insulin doses for each group were determined by recalculating different rates of TDI. These rates were determined in three groups as 80% (Group 80), 100% (Group 100) and 125% (Group 125), and an independent researcher decided by drawing lots to which group the patients would be included in. In all patients, half of the calculated daily SC insulin dose was administered as basal insulin and the other half as bolus insulin before meals, equally divided into three meals. Fingerstick blood glucose measurements were taken from the patients for 48 hours after switching to SC insulin therapy. Demographic characteristics of the patients, body mass index, laboratory datas, recorded blood glucose measurements and measurement times were recorded. Results: A total of 1251 blood glucose measurements were recorded from 75 patients. The mean rates of the recorded measurements being in the target range (110-180 mg/dl) were 37.75%, 42.65% and 60.7% for Group 80, Group 100 and Group 125, respectively (p<0.0001). The amount of time spent with the patients' blood glucose levels in the target range (TIR) was compared. TIR averages were 40.82%, 38.12% and 63.67%, respectively (p<0.0001). The amount of time spent with patients above the target range (TAR) range is divided into two as recommended in current guidelines. These were determined as TAR 1 for 180-250 mg/dl and TAR 2 for >250 mg/dl. Accordingly, TAR 1 averages were 34.15%, 40.16% and 21.99% for Group 80, Group 100 and Group 125, respectively (p=0.001); TAR 2 averages were 26.4%, 24.68% and 12.07%, respectively (p=0.05). The number of patients who developed hypoglycemia (<70 mg/dl) was compared. Hypoglycemia was observed in 3 patients (11.5%) in Group 80, 3 patients (15%) in Group 100, and 7 patients (24.1%) in Group 125. The difference between the three groups was not found to be statistically significant (p=0.44). Conclusion: The administration of the 125% protocol in the transition from IV insulin therapy to SC therapy in hospitalized patients provides more effective blood sugar regulation without increasing the risk of complications compared to other protocols in the literature.
Introduction: Hyperglycemia is a potent predictor of morbidity and mortality, as well as being related to the severity of the underlying disease for hospitalized patients. Favorable effects on mortality of hyprglycemia management has been shown in different studies. The most effective method in the management of hyperglycemia in hospitalized patients is intravenous (IV) insulin administration. However, reasons such as the need for frequent blood glucose monitoring and the limitation of mobilization in patients, make difficulties for administration of IV insulin therapy. The most effective method in the management of hyperglycemia in hospitalized patients is intravenous (IV) insulin administration. Current guidelines recommend switching from IV insulin therapy to subcutaneous (SC) insulin therapy in hemodynamically stable patients with well-regulated blood glucose. We aimed to find the dose rate that can be used most effectively and safely in the transition from IV therapy to SC therapy in our clinic. Methods: In this study, 82 patients who were hospitalized in Ege University Medical Faculty Hospital Internal Medicine Clinic in 2021 and treated with IV insulin due to hyperglycemia were included. 7 of these patients were excluded from the study for various reasons. Total daily insulin (TDI) was calculated by multiplying the insulin amount (U) taken by the patients during the 6-hour period when the blood sugar was in the target range (110-180 mg/dl) under IV insulin therapy. The daily SC insulin doses for each group were determined by recalculating different rates of TDI. These rates were determined in three groups as 80% (Group 80), 100% (Group 100) and 125% (Group 125), and an independent researcher decided by drawing lots to which group the patients would be included in. In all patients, half of the calculated daily SC insulin dose was administered as basal insulin and the other half as bolus insulin before meals, equally divided into three meals. Fingerstick blood glucose measurements were taken from the patients for 48 hours after switching to SC insulin therapy. Demographic characteristics of the patients, body mass index, laboratory datas, recorded blood glucose measurements and measurement times were recorded. Results: A total of 1251 blood glucose measurements were recorded from 75 patients. The mean rates of the recorded measurements being in the target range (110-180 mg/dl) were 37.75%, 42.65% and 60.7% for Group 80, Group 100 and Group 125, respectively (p<0.0001). The amount of time spent with the patients' blood glucose levels in the target range (TIR) was compared. TIR averages were 40.82%, 38.12% and 63.67%, respectively (p<0.0001). The amount of time spent with patients above the target range (TAR) range is divided into two as recommended in current guidelines. These were determined as TAR 1 for 180-250 mg/dl and TAR 2 for >250 mg/dl. Accordingly, TAR 1 averages were 34.15%, 40.16% and 21.99% for Group 80, Group 100 and Group 125, respectively (p=0.001); TAR 2 averages were 26.4%, 24.68% and 12.07%, respectively (p=0.05). The number of patients who developed hypoglycemia (<70 mg/dl) was compared. Hypoglycemia was observed in 3 patients (11.5%) in Group 80, 3 patients (15%) in Group 100, and 7 patients (24.1%) in Group 125. The difference between the three groups was not found to be statistically significant (p=0.44). Conclusion: The administration of the 125% protocol in the transition from IV insulin therapy to SC therapy in hospitalized patients provides more effective blood sugar regulation without increasing the risk of complications compared to other protocols in the literature.
Açıklama
Anahtar Kelimeler
Hiperglisemi, İntravenöz, Subkutan, İnsülin, Geçiş, Hyperglycemia, Intraveonus, Subcutaneous, Transition
