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Keywords:

  • glucocorticoids;
  • hyperglycemia;
  • treatment strategy
  • 糖皮质激素,高血糖,治疗策略

Abstract

Corticosteroid-induced hyperglycemia is a common medical problem that can lead to frequent emergency room visits, hospital admissions and prolonged hospital stay, in addition to the well known morbidity associated with hyperglycemia. However, the diagnosis and treatment of corticosteroid-induced hyperglycemia is surprisingly undervalued by most professionals, probably because of the lack of quality studies to determine specific strategies of action. In the present review, we discuss the pathophysiology of corticosteroid-induced hyperglycemia, focusing on diverse patterns of hyperglycemia induced by the different formulations, and provide clues for diagnosis based on the duration of treatment and the administration schedule of corticosteroids. We propose a treatment strategy based on both the pathophysiology of the process and the mechanism of action of different corticosteroids, and take into account dosing and administration timing to predict the duration of therapy. Finally, we propose treatment goals that differ slightly between the transient and continuous use of corticosteroids based on evidence from clinical practice guidelines of diabetes care both in ambulatory and hospital settings.

摘要

糖皮质激素诱导的高血糖是一个常见的医疗问题,它使患者频繁至急诊室就诊,并延长入院及住院时间,除此之外还有众所周知的高血糖导致死亡率增加的问题。然而,令人惊讶的是糖皮质激素诱导高血糖的诊断与治疗被大多数的专业人员低估了,这可能是因为缺乏高质量的关于制定具体治疗策略的研究。在本综述中,我们讨论了糖皮质激素诱导高血糖的病理生理学,聚焦于由不同制剂导致的多种模式的高血糖,并根据皮质激素治疗的持续时间与给药时间表提供了诊断线索。根据不同皮质激素的病理生理学过程以及作用机制,我们提出了一种治疗策略,并根据剂量、给药时间来预测治疗持续时间。最后,根据来自糖尿病治疗方面的临床实践指南证据,针对门诊与住院患者提出了一个治疗目标,短暂和持续使用皮质激素治疗之间具有轻微的差别。