糖皮质激素诱发的高血糖:一个被忽视的问题

IF 3.9 3区 医学 Q2 ENDOCRINOLOGY & METABOLISM
Endocrinology and Metabolism Pub Date : 2024-04-01 Epub Date: 2024-03-27 DOI:10.3803/EnM.2024.1951
Jung-Hwan Cho, Sunghwan Suh
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引用次数: 0

摘要

糖皮质激素具有强效治疗反应,被广泛用于治疗各种疾病,包括冠状病毒病2019(COVID-19)感染。然而,超过三分之一接受糖皮质激素治疗的患者会出现糖皮质激素诱导的高血糖(GIH),这一问题往往被忽视。为了改善需要使用糖皮质激素治疗的疾病的临床过程和预后,正确处理 GIH 至关重要。GIH 的主要病理生理学包括全身性胰岛素抵抗,这加剧了肝脏脂肪变性和内脏肥胖,以及肌肉和脂肪组织的蛋白分解和脂肪分解,再加上 β 细胞功能障碍。对于接受糖皮质激素治疗的患者,应通过详细的基线评估进行风险分层,建议经常进行血糖监测,以发现 GIH 的发生,尤其是高危人群。确诊为 GIH 并需要治疗的患者应遵循以胰岛素为中心的治疗方案,该方案因患者是住院病人还是门诊病人以及所用糖皮质激素的类型和剂量而异。在预防低血糖的同时维持正常血糖的理想策略是将基础胰岛素和修正剂量与持续血糖监测系统相结合。本综述重点介绍目前对 GIH 的认识和最新证据,并结合 COVID-19 大流行中获得的启示。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Glucocorticoid-Induced Hyperglycemia: A Neglected Problem.

Glucocorticoids provide a potent therapeutic response and are widely used to treat a variety of diseases, including coronavirus disease 2019 (COVID-19) infection. However, the issue of glucocorticoid-induced hyperglycemia (GIH), which is observed in over one-third of patients treated with glucocorticoids, is often neglected. To improve the clinical course and prognosis of diseases that necessitate glucocorticoid therapy, proper management of GIH is essential. The key pathophysiology of GIH includes systemic insulin resistance, which exacerbates hepatic steatosis and visceral obesity, as well as proteolysis and lipolysis of muscle and adipose tissue, coupled with β-cell dysfunction. For patients on glucocorticoid therapy, risk stratification should be conducted through a detailed baseline evaluation, and frequent glucose monitoring is recommended to detect the onset of GIH, particularly in high-risk individuals. Patients with confirmed GIH who require treatment should follow an insulin-centered regimen that varies depending on whether they are inpatients or outpatients, as well as the type and dosage of glucocorticoid used. The ideal strategy to maintain normoglycemia while preventing hypoglycemia is to combine basal-bolus insulin and correction doses with a continuous glucose monitoring system. This review focuses on the current understanding and latest evidence concerning GIH, incorporating insights gained from the COVID-19 pandemic.

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来源期刊
Endocrinology and Metabolism
Endocrinology and Metabolism Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
6.60
自引率
5.90%
发文量
145
审稿时长
24 weeks
期刊介绍: The aim of this journal is to set high standards of medical care by providing a forum for discussion for basic, clinical, and translational researchers and clinicians on new findings in the fields of endocrinology and metabolism. Endocrinology and Metabolism reports new findings and developments in all aspects of endocrinology and metabolism. The topics covered by this journal include bone and mineral metabolism, cytokines, developmental endocrinology, diagnostic endocrinology, endocrine research, dyslipidemia, endocrine regulation, genetic endocrinology, growth factors, hormone receptors, hormone action and regulation, management of endocrine diseases, clinical trials, epidemiology, molecular endocrinology, neuroendocrinology, neuropeptides, neurotransmitters, obesity, pediatric endocrinology, reproductive endocrinology, signal transduction, the anatomy and physiology of endocrine organs (i.e., the pituitary, thyroid, parathyroid, and adrenal glands, and the gonads), and endocrine diseases (diabetes, nutrition, osteoporosis, etc.).
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