BACKGROUND: The impact of intensive insulin therapy on the clinical outcomes of hospitalized patients is highly controversial. We used a protocol based on dynamic insulin administration targeted to achieve moderately tight glycemic control and tested its impact on clinical outcomes after cardiac surgery. METHODS: Patients with diabetes mellitus or random blood glucose greater than 150 mg/dL were treated in the intensive care unit with intravenous insulin, followed by a multi-injection protocol consisting of 4 glargine/aspart insulin injections in the ward, with a glycemic target of 110 to 150 mg/dL. The study cohort (n = 410) consisted of consecutive patients undergoing cardiothoracic surgery. Control patients (n = 207) were admitted during the first 8 months and treated according to standard of care. The intervention group of patients (n = 203) were operated on during the following 8 months. The main outcome measures were glycemic control and the rate of postsurgery infections. RESULTS: During the intervention, mean blood glucose ± SD was 151 ± 19 mg/dL and 157 ± 32 mg/dL in the intensive care unit and ward, respectively, versus 166 ± 27 mg/dL and 184 ± 46 mg/dL during the control period (p < 0.0001). The incidence of hypoglycemia (blood glucose less than 60 mg/dL) was low and similar in the two groups (2.5% control versus 3% intervention). Intensive insulin treatment decreased the risk for infection from 11% to 5% (56% risk reduction, p = 0.018), mainly by reducing the incidence of graft harvest site infection (6.9% versus 2.5%, p = 0.034). The incidence of atrial fibrillation after coronary artery bypass graft surgery decreased from 30% to 18% (39% risk reduction; p = 0.042). CONCLUSIONS: Moderate-intensity dynamic blood glucose control after cardiac surgery is effective and safe, and is associated with improved clinical outcomes.
BACKGROUND: The impact of intensive insulin therapy on the clinical outcomes of hospitalized patients is highly controversial. We used a protocol based on dynamic insulin administration targeted to achieve moderately tight glycemic control and tested its impact on clinical outcomes after cardiac surgery. METHODS:Patients with diabetes mellitus or random blood glucose greater than 150 mg/dL were treated in the intensive care unit with intravenous insulin, followed by a multi-injection protocol consisting of 4 glargine/aspartinsulin injections in the ward, with a glycemic target of 110 to 150 mg/dL. The study cohort (n = 410) consisted of consecutive patients undergoing cardiothoracic surgery. Control patients (n = 207) were admitted during the first 8 months and treated according to standard of care. The intervention group of patients (n = 203) were operated on during the following 8 months. The main outcome measures were glycemic control and the rate of postsurgery infections. RESULTS: During the intervention, mean blood glucose ± SD was 151 ± 19 mg/dL and 157 ± 32 mg/dL in the intensive care unit and ward, respectively, versus 166 ± 27 mg/dL and 184 ± 46 mg/dL during the control period (p < 0.0001). The incidence of hypoglycemia (blood glucose less than 60 mg/dL) was low and similar in the two groups (2.5% control versus 3% intervention). Intensive insulin treatment decreased the risk for infection from 11% to 5% (56% risk reduction, p = 0.018), mainly by reducing the incidence of graft harvest site infection (6.9% versus 2.5%, p = 0.034). The incidence of atrial fibrillation after coronary artery bypass graft surgery decreased from 30% to 18% (39% risk reduction; p = 0.042). CONCLUSIONS: Moderate-intensity dynamic blood glucose control after cardiac surgery is effective and safe, and is associated with improved clinical outcomes.
Authors: Bithika M Thompson; Joshua D Stearns; Heidi A Apsey; Richard T Schlinkert; Curtiss B Cook Journal: Curr Diab Rep Date: 2016-01 Impact factor: 4.810
Authors: Bianca Hemmingsen; Søren S Lund; Christian Gluud; Allan Vaag; Thomas Almdal; Christina Hemmingsen; Jørn Wetterslev Journal: BMJ Date: 2011-11-24