HYPERGLYCEMIA AS A STRESS RESPONSE OF THE ORGANISM IN COMBAT INJURIES (LITERATURE REVIEW AND OWN EXPERIENCE)

Abstract

Topicality. In conditions of full-scale war, the treatment of military personnel with multiple injuries requires a comprehensive approach to correcting metabolic disorders. Stress hyperglycemia is a typical pathophysiological response to combat trauma, which occurs as a result of activation of the hypothalamic-pituitary-adrenal axis and the development of acute insulin resistance. Uncontrolled stress hyperglycemia correlates with increased mortality, the risk of septic complications, and prolonged hospitalization.
Purpose of the work: based on the analysis of modern literature and our own observations, to investigate the features of the development of stress hyperglycemia in wounded middle-aged men, to analyze diagnostic approaches, and to evaluate the effectiveness of glycemic control strategies depending on the nature of combat trauma.
Materials and methods. A review of global protocols and a retrospective analysis of 596 cases of stress hyperglycemia in military personnel (mean age — 43.6 ± 3.2 years) were performed. Glucose concentration was determined by the glucose oxidase method (Roche Cobas analyzer). The work complies with the standards of GCP, GLP and the Declaration of Helsinki.
Results. It was found that in 93 % of cases stress hyperglycemia accompanied severe combined injuries with the development of acute respiratory distress syndrome and pneumonia; in burns — 5.1 %, in spinal injuries — 1.9 %. In 70 % of cases, hyperglycemia was aggravated by the use of hydroprednisolone. Severe glycemia (10.1-14.0 mmol/L) was recorded in 72.4 % of people, critical (over 14.1 mmol/L) — in 11.9 %, with peak values up to 28.7 mmol/L. Correction was performed with short-acting insulins: fractional (80 %) or continuous infusion (20 %), which was most appropriate in critical conditions.
Conclusions. To differentiate acute stress hyperglycemia from undiagnosed diabetes, HbA1c screening and use of the stress hyperglycemia coefficient are critically important. World practice has shifted the emphasis to moderate control (target level <200 mg/dL or 100-180 mg/dL). Timely glycemic control is an integral part of anti-shock therapy. Implementation of HbA1c-targeted protocols and individualized insulin therapy minimizes the risks of glucose toxicity and improves overall surgical outcomes in military personnel.