OBJECTIVE: To determine whether once-daily insulin glargine could provide better glycemic control after an abdominal surgical procedure than the traditional use of sliding scale regular insulin (SSRI). METHODS: Because 20% to 30% of patients undergoing gastric bypass have a history of overt diabetes and another 5% to 10% are estimated to have impaired glucose tolerance, we chose to study these patients. We treated 81 patients with postoperative blood glucose levels of more than 144 mg/dL after a Roux-en-Y gastric bypass surgical procedure. They were randomized to receive either SSRI or insulin glargine either directly or after initial intravenous insulin infusion in the intensive care unit (ICU). RESULTS: Overall, the mean blood glucose level after SSRI therapy was 154 +/- 33 mg/dL, and the mean blood glucose value after insulin glargine treatment was 134 +/- 30 mg/dL (P<0.01). The mean blood glucose level for patients first treated with intravenous insulin infusion in the ICU was 125 mg/dL, in comparison with 145 mg/dL in the non-ICU patients whose treatment began directly with 0.3 U/kg of insulin glargine. Of 926 blood glucose measurements, only 3 were less than 60 mg/dL. CONCLUSION: In this study, control of postoperative hyperglycemia was significantly better with use of insulin glargine in comparison with SSRI therapy, and hypoglycemia was very infrequent.
RCT Entities:
OBJECTIVE: To determine whether once-daily insulinglargine could provide better glycemic control after an abdominal surgical procedure than the traditional use of sliding scale regular insulin (SSRI). METHODS: Because 20% to 30% of patients undergoing gastric bypass have a history of overt diabetes and another 5% to 10% are estimated to have impaired glucose tolerance, we chose to study these patients. We treated 81 patients with postoperative blood glucose levels of more than 144 mg/dL after a Roux-en-Y gastric bypass surgical procedure. They were randomized to receive either SSRI or insulinglargine either directly or after initial intravenous insulin infusion in the intensive care unit (ICU). RESULTS: Overall, the mean blood glucose level after SSRI therapy was 154 +/- 33 mg/dL, and the mean blood glucose value after insulinglargine treatment was 134 +/- 30 mg/dL (P<0.01). The mean blood glucose level for patients first treated with intravenous insulin infusion in the ICU was 125 mg/dL, in comparison with 145 mg/dL in the non-ICU patients whose treatment began directly with 0.3 U/kg of insulinglargine. Of 926 blood glucose measurements, only 3 were less than 60 mg/dL. CONCLUSION: In this study, control of postoperative hyperglycemia was significantly better with use of insulinglargine in comparison with SSRI therapy, and hypoglycemia was very infrequent.
Authors: Wiebke K Fenske; Dimitri J Pournaras; Erlend T Aasheim; Alexander D Miras; Nicola Scopinaro; Samantha Scholtz; Carel W le Roux Journal: Obes Surg Date: 2012-01 Impact factor: 4.129
Authors: Luis Enrique Colunga-Lozano; Franscisco Javier Gonzalez Torres; Netzahualpilli Delgado-Figueroa; Daniel A Gonzalez-Padilla; Adrian V Hernandez; Yuani Roman; Carlos A Cuello-García Journal: Cochrane Database Syst Rev Date: 2018-11-29