| Objective:Hierarchical diagnosis and treatment policy makes more difficult and critical patients will visit tertiary A general hospitals.Blood sugar is closely related to stress factors.To compare and analyze the detection rate,distribution characteristics and related risk factors of hyperglycemia in non-endocrinological inpatients before and after hierarchical diagnosis and treatment,which will increase the attention of non-endocrinologists to hyperglycemiaMethods:The plasma grape level>7.8 mmol/L at any time during hospitalization is hyperglycemia in hospital[1].The subj ects were hyperglycemic patients admitted to non-endocrine departments of People's Hospital Affiliated to Shanxi Medical University from February 1,2017 to January 31,2018.From February 1,2017 to July 31,2017,the patients were divided into pre-treatment group and post-treatment group from August 1,2017 to January 31,2018.A total of 4364 patients with hyperglycemia in non-endocrinological hospital were collected,including 2362 cases in internal medicine(except endocrinology)and 1932 cases in surgery.The detection rate of hyperglycemia in hospital was counted.The data of gender,age,main diagnosis,history of using special drugs such as glucocorticoids,history of diabetes mellitus,operation,high glucose infusion,history of enteral/parenteral nutrition and whether to consult with endocrinology specialist were collected.Record the blood glucose at any time point(glucose oxidase method),including fasting plasma glucose(FBG),pre-meal/post-meal blood glucose,oral glucose tolerance test(OGTT),and glycosylated hemoglobin(HbAIC,high-pressure liquid chromatography),and calculate the relevant data.The detection rate of hyperglycemia and its distribution characteristics were analyzed.The risk factors of hyperglycemia in ICU patients were analyzed by logistic regression.Results:1.Distribution of hyperglycemia in hospital before and after hierarchical diagnosis and treatment a total of one year:1.1 General information:The total detection rate of hyperglycemia in non-endocrinological inpatients was 7.57%(4364/57627),with an average age of(60.20±16.14)years and a male-to-female ratio of 1.28:1.1.2 Detection rate and distribution characteristics of hyperglycemia in internal and surgical hospitals:the detection rate of hyperglycemia in internal medicine department was 8.46%(2362/27916),the ratio of male to female was 1.54:1,the average age was(61.01±13.96)years;the detection rate of surgery was 6.56%(1932/29461),the ratio of male to female was 1.03:1,and the average age was(59.03±14.14).The detection rates of geriatrics,cardiology and neurology were 16.90%,13.57%and 12.32%respectively;neurosurgery,general surgery and interventional surgery were 17.11%,12.94%and 11.37%respectively;coronary atherosclerotic heart disease(10%),acute ischemic cerebral infarction(7%)and acute pancreatitis(5%)were the most common diseases in hospital.1.3 Types of in-hospital hyperglycemia:2424 diabetic patients(55.54%)were previously diagnosed out-of-hospital;864 unknown hyperglycemic patients(19.80%);757 newly diagnosed diabetes patients(17.35%);319 stress hyperglycemic patients(7.31%).1.4 Non-endocrinology Department paid more attention to hospitalized patients withhyperglycemia:The detection rates of OGTT,glycosylated hemoglobin and both in non-endocrinology department were higher than those in surgery department(X2=79.68,197.29,67.48,P<0.001),and the consultation rate with endocrinology department was higher than that in surgery department,with no significant difference(X2=1.46,P=0.226).2.Detection rate and distribution characteristics of hyperglycemia before and after hierarchical diagnosis and treatment:2.1 General information:The detection rate was 7.18%(2060/28678)before hierarchical diagnosis and treatment,with an average age of(60.61±14.30)years and a male-to-female ratio of 1.32:1.The detection rate of internal medicine and surgery was 8.52%and 6.48%,respectively.The detection rate after the policy was 7.96%(2304/28949),with an average age of(59.79 ±17.76)years and a male-to-female ratio of 1.25:1.The detection rate of internal medicine and surgery was 8.40%and 6.64%respectively.The detection rate of hyperglycemia in hospital after hierarchical diagnosis and treatment was higher than that before this policy,and the difference was statistically significant(P<0.05).2.2 Distribution characteristics of hyperglycemia in internal and surgical hospitals:Before hierarchical diagnosis and treatment,the high incidence departments of internal medicine were geriatrics(17.6%),cardiology(13.7%)and rehabilitation medicine(11.5%).The high incidence departments of surgery were neurosurgery(17.2%),general surgery(12.6%)and interventional surgery(11.4%).The high incidence diseases were coronary atherosclerotic heart disease(11%),acute ischemic cerebral infarction(7%)and acute pancreatitis(4%).The high incidence departments of internal medicine were geriatrics(16.2%),neurology(13.5%)and cardiology(13.4%)after hierarchical diagnosis and treatment,and the detection rates of surgical high incidence departments were same as before.They were 17.1%,13.3%and 11.3%respectively.Coronary atherosclerotic heart disease(14%),acute ischemic cerebral infarction(12%)and acute pancreatitis(5%)accounted for a higher proportion of the type of hyperglycemia in hospital.There was no significant difference in the types of hyperglycemia,but the detection rate of various types of diseases increased.2.3 Before and after grading diagnosis,non-endocrinology Department paid more attention to hospital hyperglycemia:The detection rates of OGTT,glycosylated hemoglobin and both of them in non-endocrinology department after hierarchical diagnosis and treatment were higher than those before it implemented(P<0.05),and the consultation rate of Endocrinology specialty was significantly increased after hierarchical diagnosis and treatment(P=<0.001).3.Statistics of causes and related factors of hyperglycemia in hospital(single item):72.89%of patients with basic diabetes mellitus(including previously diagnosed diabetes mellitus and newly diagnosed diabetes mellitus),54.40%of patients aged 40 years to 65 years,47.80%of patients during perioperative period,35.88%of patients with hyperglycemia infusion,20.60%of patients with enteral/parenteral nutrition,5.75%of patients with pancreatic-related diseases and 2.38%of patients with glucocorticoid use.4.Logistic analysis revealed that perioperative period,diabetes mellitus and the history of glucocorticoid use were independent factors for the prevalence of hyperglycemia in ICU patients[OR(95%CI)respectively,1.015(1.169?4.265)?2.999(1.487?6.049)?5.456(2.067?14.398),all P<0.05].Conclusion:1.The detection rate of hyperglycemia in tertiary and first-class general hospitals is higher.The main type of hyperglycemia in hospitals is diabetes patients diagnosed outside the hospital.Since the implementation of hierarchical diagnosis and treatment on August 1,2017,the detection rate of hyperglycemia in hospitals has been increasing,suggesting that more critical patients may be concentrated in tertiary hospitals.2.Internal medicine departments(except endocrinology)pay more attention to hyperglycemia in hospital;after this system started,both internal medicine and surgery improve the management of hyperglycemia in hospital to avoid adverse outcomes.3.History of diabetes mellitus,newly diagnosed diabetes mellitus,perioperative patients and age were the common causes of hospital hyperglycemia.4.Perioperative period,diabetes mellitus and glucocorticoid use history were closely related to the incidence of hyperglycemia in ICU patients. |
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