Treatment of hyperglycemia
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Treatment of Hyperglycemia: Current Approaches and Emerging Therapies
Introduction to Hyperglycemia Management
Hyperglycemia, or high blood sugar, is a common condition in both diabetic and non-diabetic patients, particularly in hospital settings. Effective management of hyperglycemia is crucial to prevent adverse clinical outcomes. This article synthesizes current research on various treatment strategies for hyperglycemia, including traditional insulin therapy, novel drug classes, and patient-centered approaches.
Insulin Therapy in Hospitalized Patients
Continuous and Subcutaneous Insulin
For non-critically ill hospitalized patients, insulin therapy remains a cornerstone of hyperglycemia management. Continuous intravenous insulin infusion is often recommended for its superior glycemic control, although it can be burdensome for patients and healthcare teams. Scheduled subcutaneous insulin is a viable alternative, providing effective management with fewer logistical challenges.
Aggressive Insulin Treatment in Acute Conditions
In cases of acute cerebral infarction, aggressive correction of hyperglycemia using continuous intravenous insulin has shown better glucose control compared to usual care, without major adverse events. This approach may improve clinical outcomes and warrants further investigation.
Emerging Drug Classes for Hyperglycemia
Sodium-Glucose Cotransporter 2 (SGLT2) Inhibitors
SGLT2 inhibitors, such as dapagliflozin, have demonstrated significant efficacy in reducing HbA1c, fasting plasma glucose, and body mass index in patients with type 2 diabetes. These drugs also offer cardiovascular and renal benefits, making them a valuable addition to hyperglycemia management . However, they are associated with an increased risk of urinary and genital tract infections.
Glucagon-Like Peptide 1 (GLP-1) Receptor Agonists
GLP-1 receptor agonists are recommended for patients with type 2 diabetes, particularly those at high cardiovascular risk. These agents not only improve glycemic control but also reduce major adverse cardiovascular events and the progression of chronic kidney disease . Their use in hospitalized patients shows promise, with preliminary studies indicating improved glycemic control and reduced hypoglycemia risk.
Patient-Centered Approaches
Individualized Treatment Plans
The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) emphasize the importance of individualized treatment targets and strategies. This approach considers patient preferences, comorbidities, and specific clinical scenarios to optimize outcomes .
Comprehensive Cardiovascular Risk Management
Effective hyperglycemia management should be part of a broader cardiovascular risk reduction program. This includes lifestyle modifications, blood pressure control, lipid management, and, when appropriate, antiplatelet therapy.
Special Considerations
Steroid-Induced Hyperglycemia
Steroid-induced hyperglycemia is a common complication in patients receiving glucocorticoid therapy. Management strategies include the use of DPP-4 inhibitors, metformin, and weight-based neutral protamine Hagedorn insulin, which have shown varying degrees of success in clinical trials.
Hyperglycemia in Artificial Nutrition
Patients receiving enteral or parenteral nutrition are at increased risk of hyperglycemia. Continuous intravenous insulin infusion offers the best glycemic control, but scheduled subcutaneous insulin is also effective and more practical for non-critically ill patients.
Conclusion
The management of hyperglycemia involves a combination of traditional insulin therapies and emerging drug classes, tailored to individual patient needs. Continuous advancements in diabetes technology and a patient-centered approach are essential for optimizing treatment outcomes. Further research is needed to refine these strategies and explore new therapeutic options.
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