Glycemic Control of Hospitalized Patients at a Medical Center in Taiwan

臺灣某一家醫學中心住院病人的血糖控制狀況

林世鐸(Shi-Dou Lin) ； 郭仁富(Jeng-Fu Kuo) ； 林美蓉(Mei-Jung Lin) ； 張雅稜(Ya-Leng Jhang)

《The Changhua Journal of Medicine》 14卷2期 (2016/06) Pp. 49-56

https://doi.org/10.6501/CJM.1402.001

摘要

將住院病人的血糖控制達標是降低住院病人發生併發症及死亡的重要因素；然而，臺灣的住院病人之血糖控制狀況從未做過分析。我們做了一個回溯性的研究，分析住院病人的血糖控制狀況。我們收集從2012年4月至6月，所有在一般病房及加護病房的床邊血糖監測(POCBG)數值。分析的指標包括：所有POCBG的平均值、所有POCBG ＜ 70 mg/dL、70 ~ 250 mg/dL及＞ 250 mg/dL的比率、所有病人每天POCBG均值的平均值(PDW-MG)及所有PDW-MG大於180 mg/dL的比率。利用這些指標，比較內外科加護病房、內外科一般病房及各病房之間的差異。POCBG的平均值及PDW-MG值在一般病房各為192.4 mg/dL及183.1 mg/dL，在加護病房各為196.3 mg/dL及187.7 mg/dL。住院病人的血糖控制品質，在內科一般病房控制的比外科一般病房不好，但在內外科加護病房的差異則較小。各內科病房間的血糖控制品質是不一致的。總而言之，本院住院病人的血糖控制狀況是未達現行指引的標準。建立改善的策略是迫切需要的，而執行策略後帶來的臨床效益則需要進一步的分析。

關鍵字

糖尿病 ； 血糖控制 ； 醫院 ； 品質 ； 臺灣

並列摘要

Achieving the glycemic target is essential to reduce morbidity and mortality in hospitalized patients; however, the status of glycemic control in Taiwan has not yet been evaluated. We conducted a retrospective study to evaluate the status of glycemic control in our hospital. We collected all the point-of-care blood glucose (POC-BG) data generated in general wards and intensive care units (ICUs) between April 2012 and June 2012. Parameters including mean of total POC-BG values, proportion of any POC-BG value less than 70 mg/dL, more than 250 mg/dL and 70 ~ 250 mg/dL, patient-day weighted mean glucose (PDWMG) value and percentage of PDW-MG value more than 180 mg/dL were compared between patients in medical and surgical wards, patients in medical and surgical ICUs, and among patients in each of the medical wards and surgical wards. The mean glucose and PDW-MG values were 192.4 mg/dL and 183.1 mg/dL in the general wards and 196.3 mg/dL and 187.7 mg/dL in the ICUs, respectively. The quality of inpatient glycemic control was poorer for patients in medical wards than in surgical wards, but the difference was smaller between patients in medical and surgical ICUs. The quality of glycemic control among patients in the different medical wards was inconsistent. In summary, the quality of inpatient glycemic control in our hospital was found to be suboptimal as compared with the current guidelines. The development of a strategy for improvement is critical, and the subsequent clinical effectiveness needs further investigation.

並列關鍵字

diabetes ； glycemic control ； hospital ； quality ； Taiwan