ABSTRACT
ABSTRACT The management of diabetes mellitus (DM) requires maintaining glycemic control, and patients must keep their blood glucose levels close to the normal range to reduce the risk of microvascular complications and cardiovascular events. While glycated hemoglobin (A1C) is currently the primary measure for glucose management and a key marker for long-term complications, it does not provide information on acute glycemic excursions and overall glycemic variability. These limitations may even be higher in some special situations, thereby compromising A1C accuracy, especially when wider glycemic variability is expected and/or when the glycemic goal is more stringent. To attain adequate glycemic control, continuous glucose monitoring (CGM) is more useful than self-monitoring of blood glucose (SMBG), as it is more convenient and provides a greater amount of data. Flash Glucose Monitoring (isCGM /FGM) is a widely accepted option of CGM for measuring interstitial glucose levels in individuals with DM. However, its application under special conditions, such as pregnancy, patients on hemodialysis, patients with cirrhosis, during hospitalization in the intensive care unit and during physical exercise has not yet been fully validated. This review addresses some of these specific situations in which hypoglycemia should be avoided, or in pregnancy, where strict glycemic control is essential, and the application of isCGM/FGM could alleviate the shortcomings associated with poor glucose control or high glycemic variability, thereby contributing to high-quality care.
ABSTRACT
Este trabalho tem como objetivo identificar e caracterizaros pacientes hiperglicêmicos hospitalizados deacordo com dados demográficos, setor de internação,esquemas de insulinoterapia, glicemia de jejum, médiaglicêmica, tempo de internação e presença de hipoglicemia.Trata-se de um estudo transversal em que foramanalisados 63 prontuários de pacientes hiperglicêmicosdo Hospital Governador Celso Ramos, de Florianópolis,Santa Catarina. A análise descritiva foi realizadapor meio do programa estatístico SPSS 19.0 e as comparaçõesutilizaram o Teste Z e Teste T de Student. Entreos 63 pacientes recrutados para o estudo, 52 (82,5%)estavam em tratamento somente com esquema SlidingScale Insulin (SSI) e 11 (17,4%) com esquema basal--bolus (B-B). No grupo SSI, 25 (48,1%) apresentavamdiagnóstico prévio de Diabetes Mellitus (DM), contra10 (90,9%) dos pacientes do grupo B-B (p =0,02). Nogrupo SSI, 6 (11,5%) apresentaram hipoglicemia, bemcomo 6 (54,5%) dos pacientes do grupo B-B (p<0,01).A média da glicemia de jejum encontrada no grupo SSIfoi de 137,8mg/dL, enquanto o grupo B-B mostrou umamédia de 183,1mg/dL (p =0,04). A grande maioria dospacientes hospitalizados foram tratados com esquemade insulina SSI e um número significativo não apresentavadiagnóstico prévio de DM. O número reduzido depacientes em esquema basal-bolus dificultou a análisecomparativa entre os grupos.
The objectives of this work is to identify and tocharacterize hyperglycemic patients according todemographic data and inpatient sector, as well as toevaluate insulin therapy regimens according to fastingglucose, mean glycemic index, length of hospital stayand the presence of hypoglycemia. It is a cross-sectionalstudy in which 63 handbooks of hyperglycemicpatients from Hospital Governador Celso Ramos ofFlorianópolis/Brazil were analyzed. A descriptiveanalysis was carried out through SPSS 19.0 statisticalsoftware and comparisons through Student?s Z-Test andT-Test. Among the 63 patients recruited for the study,52 (82.5%) were treated with Sliding Scale Insulin (SSI)and 11 (17.4%) with basal-bolus (B-B). In SSI group, 25patients (48.1%) presented a previous diagnosis ofdiabetes while the same diagnosis was presented in10 (90.9%) of B-B group (p =0.02). Among SSI group, 6(11.5%) presented hypoglycemia detection as well as 6(54.5%) from B-B group (p<0.01). The average amountof venous glucose found in SSI group was 137.8mg/dlwhereas B-B group displayed an average of 183.1mg/dl (p =0.04). The great majority of inpatients weretreated with an insulin regimen according to capillaryblood glucose and a significant number of them had notpresented a previous diagnosis of DM. The small amountof patients in basal-bolus hampered a comparativeanalysis between the groups.