diabete in ospedale
DESCRIPTION
gestione del diabete nel paziente ospedalizzatoTRANSCRIPT
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Il controllo glicemico nel paziente ospedalizzato
Dott. G. GRUTTADAURIA
Unità operativa di Medicina Interna
Presidio ospedaliero S’Elia- Caltanissetta
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Dimensioni del problema
In Italia i dati di prevalenza del
diabete nei pazienti ospedalizzati
oscillano tra il 6 ed il 24%
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Numero di pazienti dimessi con diagnosi di diabete nel 2009 dall’Ospedale S’Elia
Reparti Diagnosi secondaria
Diagnosi principale
Totale Totale dimessi Percentuale
Cardiologia 167 0 167 684 24%
UTIC 96 0 96 349 27.5%
Chirurgia gen. 16 9 25 873 2.8%
Chirurgia vasc. 104 2 106 438 24%
Malattie inf. 19 0 19 986 1.9%
Medicina 221 29 250 978 25.5%
Neurochirurgia 38 0 38 385 9.8%
Neurologia 172 1 173 949 18.3%
Oculistica 9 1 10 164 6%
Oncologia 134 0 134 717 18.6%
Pneumologia 74 0 74 516 14.3%
Ortopedia 79 0 79 672 11.7%
Ematologia 22 0 22 200 11%
Urologia 112 0 112 868 12.9%
Totale 1278 42 1320 12247 10.7%
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La correzione dell’iperglicemia in
ospedale riduce mortalità e
morbilità(American Diabetes Association. Economic costs of
diabetes in the U.S. in 2007)
Diabetes Care. 2008;31: 596-615
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• Il miglioramento del controllo glicemico migliora la prognosi dei pazienti con iperglicemia?
• Quali livelli glicemici possono essere raccomandati nelle differenti popolazioni di pazienti?
• Quali opzioni di trattamento sono disponibili per ottenere livelli glicemici ottimali in maniera sicura ed efficace in specifiche situazioni cliniche?
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Il diabete è associato a:
• Maggiore durata dei ricoveri.
• Maggiore costo dei ricoveri.
• Peggior prognosi per molte patologie.
• Elevato rischio di ricoveri ripetuti.
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Tominaga M, et al Diabetes Care 1999;22:920–924.
Correlazione tra livelli di glicemia e mortalità
1.00
0.98
0.96
0 7
0.90
1.00
0 7
NGT (2016)
DM (253)
IGT (382)
*p<0.05
0.88
**
**
**
* **
** *
**
** 0.988
0.962
0.954
Tutte le Cause
Anni
Sop
ravv
iven
za c
umul
ativ
a
Mortalità CVD
0.96
0.92
0.98
0.94
0.97
0.99
1 2 3 4 5 6 1 2 3 4 5 6
Anni
* p<0.01
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Iperglicemia e mortalità intraospedaliera
Bruno A, De Feo ME, Orrasch M. L’iperglicemia in Ospedale. Pacini Ed. 2007
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Tipologia dei pazienti
• Diabete mellito noto pre-esistente al ricovero.
• Diabete mellito di prima diagnosi durante la degenza, persistente dopo il ricovero.
• Iperglicemia correlata alla degenza: iperglicemia comparsa per la prima volta durante il ricovero e regredita alla dimissione.
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Mortalità intraospedaliera e glicemia al ricovero
Bruno A, De Feo ME, Orrasch M. L’iperglicemia in Ospedale. Pacini Ed. 2007
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• Gli interventi volti a ridurre i livelli di glicemia hanno determinato un miglioramento della prognosi in alcuni ma non in tutti gli studi.
• Diversi recenti trials clinici in pazienti critici non hanno evidenziato alcuna riduzione della mortalità nei pazienti trattati in modo intensivo rispetto ai pazienti in trattamento convenzionale.
• In alcuni trials il trattamento intensivo si è associato ad un incremento della mortalità (NICE SUGAR study)
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Lo studio Digami 2, effettuato su 1253 pazienti, con IMA e diabete, trattati con le stesse modalità del Digami 1, non ha mostrato alcun decremento della mortalità
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Quali livelli glicemici possono essere raccomandati nelle differenti popolazioni di
pazienti?
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Quali opzioni di trattamento sono disponibili per ottenere livelli glicemici ottimali in maniera sicura ed efficace in specifiche situazioni cliniche?
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•Paziente critico•Paziente non critico
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Caso clinico
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