Effect of blood glucose management on the prognosis in Tibetan patients at high elevations with acute chronic obstructive pulmonary disease and Type 2 diabetes mellitus

SUN Qin; YIN Egao; ZHOU Zhenfeng; TANG Yi; ZHANG Min

Abstract：Objective: To investigate the effects of risk factors such as blood glucose level and its variability on outcome of Tibetan patients at high elevations with acute chronic obstructive pulmonary disease (AECOPD) and type 2 diabetes mellitus (T2 DM). Methods: AECOPD patients with T2 DM were enrolled in this study. All patients enrolled were Tibetan at high elevation. The fingertip blood glucose was monitored regularly daily during hospitalization. The blood glucose level and its fluctuation were assessed by mean fasting blood glucose (FBG) and standard deviation of self-measured blood glucose (SDBG). Acute physiology and chronic health evaluation-Ⅱ (APACHE-Ⅱ) assessed the patient's condition, first APACHE-Ⅱ score was given within 24 hours and second 4-7 days later, time-standardized two APACHE-Ⅱ score difference (Δ APACHE) was calculated, analyzed the correlation between FBG, SDBG and Δ APACHE and length of stay. Results : All 5 6 patients, aged (67. 55 ± 3. 28), were enrolled in the study. During hospitalization, Δ APACHE was (2. 06 ± 0. 51), average length of stay (days) was (12. 3 ± 2. 8), FBG (while in hospital) was (8. 04 ± 1. 55) mmol/L, and SDBG was (3. 80 ± 0. 47) mmol/L. Patients were divided into group A (FBG ＜ 7 mmol/L) and group B (FBG＞ 7 mmol/L) according to FBG, or group C (SDBG ＜2 mmol/L), group D (＞ 2 mmol/L). Hospitalization time and Δ APACHE were significantly different between patients in different groups (P ＜ 0. 05). Pearson's correlation analysis show that Δ APACHE is negatively correlated with FBG (r =-0. 540, P ＜ 0. 05), and negatively correlated with SDBG (r =-0. 562, P ＜ 0. 05). Conclusion: The blood glucose level and its variability were negatively correlated with pathogenesis and hospitalization time of AECOPD patients with T2 DM. Improving the quality of strategic hospital glycemic management (maintaining appropriate and stable blood glucose levels) may accelerate the improvement of AECOPD and shorten the hospitalization time, therefore reduce the pain of patients and medical expenses