| Abstract | Uvod: Hiperglikemija uzrokovana medijatorima stresa i upale česta je u teškoj akutnoj
bolesti. Glavni rizični čimbenik za njen nastanak jest težina bolesti, međutim
hiperglikemiju ne razviju svi teško bolesni pacijenti, dok ju neki razviju i u blažem obliku
bolesti. Hipoteza istraživanja jest da akutna bolest razotkriva latentan poremećaj
metabolizma glukoze, koji se normalizira nakon izlječenja, ali ostaje rizik razvoja
šećerne bolesti tipa 2. ----- Ispitanici i metode: U istraživanje su uključeni bolesnici primljeni u Zavod za
intenzivnu medicinu Klinike za unutrašnje bolesti KBC Zagreb zbog akutnog
koronarnog sindroma (ACS), sepse, plućne embolije, plućnog edema i respiratorne
insuficijencije. Bolesnici bez poznate šećerne bolesti su podijeljeni u skupinu
hiperglikemije (GUK>7.8 mmol/l izmjeren u najmanje 2 navrata) i normoglikemije.
Postojanje ranije neprepoznate šećerne bolesti isključeno je određivanjem
glukoziliranog hemoglobina, mjerenjem glukoze natašte na dan otpusta te oralnim
testom opterećenja glukozom četiri do šest tjedana nakon otpusta iz bolnice. ----- Rezultati: Prevalencija hiperglikemije iznosila je 30.6%. Hiperglikemija je bila češća u
skupini bolesnika sa sepsom i ostalim dijagnozama (plućna embolija, plućni edem,
respiratorna insuficijenija) (43%), nego s akutnim koronarnim sindromom (20.2%).
Prosječne vrijednosti koncentracije glukoze su bile 10.2 (8.9 - 13) mmol/l u skupini
hiperglikemije i 5.7 (5 - 6.4) mmol/l u skupini normoglikemije. Bolesnici u skupini
hiperglikemije su bili stariji, imali su veći indeks tjelesne mase i težu bolest (veći
APACHE II, SAPS II, SOFA).
Istraživanje je završeno za 70 bolesnika u skupini hiperglikemije, od kojih je 10 (14.2%)
razvilo povećanu glikemiju natašte/ oštećenu toleranciju glukoze (IFG/IGT) i 30 (42.9%)
šećernu bolest tipa 2. 186 bolesnika u skupini normoglikemije je završilo praćenje, 10
(5.4%) ih je razvilo IFG/IGT, a 21 (11.3%) šećernu bolest. Relativni rizik nastanka
IFG/IGT iznosio je 4.13 (95% CI 1.84 - 9.24), a šećerne bolesti 4.19 (95% CI 2.61 -
6.73). ----- Zaključak: Bolesnici s hiperglikemijom tijekom teške akutne bolesti, a koji nemaju od
ranije poznatu šećernu bolest, imaju povećan rizik nastanka predijabetesa i dijabetesa
tipa 2. |
| Abstract (english) | Introduction: Critical illness is commonly complicated by hyperglycemia caused by
mediators of stress and inflammation. Severity of disease is the main risk factor for
development of hyperglycemia, but not all severely ill develop hyperglycemia and some
do even in mild disease. We hypothesized that acute disease exposes a latent
disturbance of glucose metabolism which normalizes after discharge but puts those
patients at higher risk for developing pre-diabetes and type 2 diabetes. ----- Patients and methods: Patients admitted to the intensive care unit of the University
Hospital Centre Zagreb due to acute coronary syndrome (ACS), sepsis, pulmonary
embolism, pulmonary oedema and respiratory insufficiency were included in the
research. Patients with no history of impaired glucose metabolism were divided into
hyperglycemia group (glucose >or= 7.8 mmol/l, measured on at least two occasions) and
normoglycemia group. Glycated hemoglobin, fasting glucose on the day of discharge
and oral glucose tolerance test within six weeks after discharge were all performed in
order to disclose patients with unknown diabetes or pre-diabetes who were excluded
from the research. ----- Results: Hyperglycemia was present in 30.6% of all patients. It was more frequent in
patients with sepsis and other diagnoses (pulmonary embolism, pulmonary oedema,
respiratory insufficiency) (43%) than with ACS (20.2%). Glucose concentration was
10.2 (8.9 - 13) mmol/l in the hyperglycemia, and 5.7 (5 - 6.4) mmol/l in the
normoglycemia group. Patients with hyperglycemia were older, had higher body mass
index and were more severely ill (higher APACHE II, SAPS II, SOFA score) than
patients in the normoglycemia group.
Follow-up was done on 70 patients with hyperglycemia, of which 10 (14.2%) developed
impaired fasting glucose/ impaired glucose tolerance (IFG/IGT) and 30 (42.9%)
diabetes. 186 patients in the normoglycemia group completed the follow up, of which
10 (5.4%) developed IFG/IGT, and 21 (11.3%) diabetes. Relative risk for developing
IFG/IGT was 4.13 (95% CI 1.84 - 9.24), and diabetes 4.19 (95% CI 2.61 - 6.73). ----- Conclusion: Patients with hyperglycemia during critical illness who were not
diagnosed with diabetes before or during the hospitalization should be considered a
population at increased risk for developing pre-diabetes and diabetes. |
