住院病人，血糖控制建議

自從2004年開始surviving sepsis campaign 以來
路過ICU都頭低低的，因為血糖都沒有控制得像PAPER上說得一樣完美……
可是臨床上的感覺，好像沒有差啊…

終於，最近幾年recombinant human activated protein C 好像沒有差
sugar 的話題，也成為最近討論的重點 ->結論是，不用控得這麼嚴，特別是MICU

美國醫師學會 (ACP)在Annals of Internal Medicine上刊登了住院患者嚴格控制血糖的治療指引，這項指引以ACP自家的證據等級評比系統分級，先進行系統性搜尋後，再以專家會議方式訂定建議與證據等級..

ACP的建議如下:
(1) ACP不建議對內科或非外科加護病房患者以胰島素嚴格控制血糖，不論患者是否有糖尿病病史(建議強度: 強 證據等級: 中等)
(2) ACP不建議對內科或外科加護病房患者以胰島素控制血糖至正常值，不論患者是否有糖尿病病史(建議強度: 強 證據等級: 高)
(3) ACP建議，如果使用胰島素控制住院患者血糖，建議控制在140~200 mg/dl之間(建議強度: 弱 證據等級: 中等)

Adapted from Ann Intern Med. 2011; 154: 260-7.


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