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新型冠状病毒肺炎的救治应重视血糖管理
The Management of Blood Glucose Should be Emphasized in the Treatment of COVID-19
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摘要: 新型冠状病毒肺炎（coronavirus disease 2019，COVID-19）重症及死亡患者中有较高比例的高血糖或糖尿病患者，其救治更为困难，因此良好的血糖管理在COVID-19的综合救治过程中尤为重要。住院COVID-19合并糖尿病者可根据病情程度制定相应的血糖控制目标和治疗策略。轻型COVID-19患者，建议采取严格血糖控制目标（空腹血糖4.4～6.1 mmol/L，餐后2 h血糖6.1～7.8 mmol/L）；普通型COVID-19患者，建议采取一般的血糖控制目标（空腹血糖6.1～7.8 mmol/L，餐后2 h血糖7.8～10.0 mmol/L），推荐应用皮下注射胰岛素治疗；重型或危重型COVID-19患者，建议采取相对宽松的血糖控制目标（空腹血糖7.8～10.0 mmol/L，餐后2 h血糖7.8～13.9 mmol/L），推荐采用静脉输注胰岛素治疗。由于部分患者病情变化迅速，在治疗过程中出现酮症酸中毒（diabetic ketoacidosis， DKA）或高血糖高渗状态（hyperglycemic hyperosmolar status，HHS）等，应加强血糖监测，动态评估，适时调整策略，进而保证患者安全，促进患者早日康复。Abstract: Based on the higher mortality and the higher proportion of critically ill adults in coronavirus disease 2019 (COVID-19) patients with diabetes, good inpatient glycemic control is particularly important in the comprehensive treatment of COVID-19. Individualized blood glucose target goals and treatment strategies should be made according to specific circumstances of COVID-19 inpatients with diabetes. For mild patients, a strict glycemic control target (fasting plasma glucose (FPG) 4.4-6.1 mmol/L, 2-hour postprandial plasma glucose (2 h PG) 6.1-7.8 mmol/L) are recommended; a target for the glycemic control of common type patients (FPG 6.1-7.8 mmol/L, 2 h PG 7.8-10.0 mmol/L) and subcutaneous insulin deliver therapy are recommended; a target nonfasting blood glucose range of 10.0 mmol or less per liter for severe-type COVID-19 patients, a relatively Less stringent blood glucose control target (FPG 7.8-10.0 mmol/L, 2 h PG 7.8-13.9 mmol/L) for critically ill patients and intravenous insulin infusion therapy are recommended. Due to the rapid changes in the condition of some patients, the risk of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar status (HHS) maybe occur during the treatment. Blood glucose monitoring, dynamic evaluation and timely adjustment of strategies should be strengthened to ensure patient safety and promote early recovery of patients.
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表 1 不同病情程度COVID-19合并糖尿病患者的血糖管理目标分层
Table 1. Targets for the blood glucose management in COVID-19 patients with diabetes according to the severity of the COVID-19
Severity of the COVID-19 Diabetic condition Indicator Glucose control recommendation Mild-type Younger patients or patients with a short duration of disease,
long life expectancy, no complications, and no significant
CVD, without significant hypoglycaemia.FPG 4.4-6.1 mmol/L 2 h PG 6.1-7.8 mmol/L Common type Older patients or patients with a history of Severe hypoglycaemia,
limited life expectancy, advanced microvascular or
macrovascular complications,extensive comorbid conditions
and long-standing diabetesFPG 6.1-7.8 mmol/L 2 h PG 7.8-10.0 mmol/L Severe type FPG 6.1-7.8 mmol/L 2 h PG 7.8-10.0 mmol/L Nonfasting 7.8-10.0 mmol/L Critical type FPG 7.8-10.0 mmol/L 2 h PG 7.8-13.9 mmol/L Nonfasting 7.8-11.1 mmol/L 
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