Comparison of Glycemic and Surgical Outcomes After Change in Glycemic Targets in Cardiac Surgery Patients

Abstract

OBJECTIVE To compare perioperative glycemic and long-term surgical outcomes in patients undergoing cardiac surgery before and after the recommended 2009 changes in inpatient glycemic targets. RESEARCH DESIGN AND METHODS We performed a retrospective review of patients who underwent cardiac surgery between 4 September 2007 and 30 April 2011. Comparison was made of blood glucose (BG) outcomes 3 days after surgery, and 30-day cardiac outcomes before and after a change in insulin protocol that took place on 1 September 2009, which consisted of raising the glycemic targets during intravenous insulin infusions from 80–110 mg/dL (80–110 group) to 110–140 mg/dL (110–140 group). RESULTS When compared with the 80–110 group (n = 667), the 110–140 group (n = 658) had higher mean postoperative BG levels during the intravenous insulin infusion (141 ± 15 vs. 121 ± 15 mg/dL, P < 0.001) and the subcutaneous insulin period (134 ± 24 vs. 130 ± 23 mg/dL, P < 0.001), and for 3 days postoperatively (141 ± 17 vs. 127 ± 15 mg/dL, P < 0.001). Fewer patients in the 110–140 mg/dL group experienced moderate hypoglycemia (BG <70 mg/dL) (177 vs. 73, P = 0.04). Severe hypoglycemia (BG <40 mg/dL) occurred in only one patient in the 80–110 group and three patients in the 110–140 group. There were no significant differences in mortality or surgical complication rates (with the exception of reintubation) between the groups. CONCLUSIONS The higher glycemic target of 110–140 mg/dL resulted in similar mean glucose values, with significantly less hypoglycemia and no significant differences in mortality/morbidity compared with the more strict target of 80–110 mg/dL.

Outcomes of Less Intensive Glycemic Target for a Subcutaneous Insulin Protocol in Hospitalized Patients

“…This difference was not statistically significant at the 0.05 significance level (p=0.06) and is similar to other published reports with less intensive glycemic targets 2021 .…”

Akurasi Indeks Antropometri Obesitas dalam Mempediksi Kontrol Glicemic Pasien Diabetes Mellitus Tipe 2 di Puskesmas Kota Pekanbaru

“…Kadar gula darah puasa diperoleh dari data rekam medis dan dikategorikan menjadi terkontrol (gula darah puasa 80-110mg/dL) dan tidak terkontrol (gula darah puasa >110 mg/dL). 10 Indeks massa tubuh (IMT) dihitung menggunakan rumus berat badan dibagi kuadrat tinggi badan dan dikategorikan berdasar atas kriteria WHO untuk populasi Asia (WHO Expert), yaitu: underweight (<18,5 kg/m 2 ), normal (18,5-22,9 kg/m 2 , overweight(>23-24,9 kg/m 2 ), obes tingkat I (>25-29,9 kg/m 2 ), dan obes tingkat II (>30 kg/m 2 ). Waist cirfumference (WC) diukur WHtR memiliki sensifitas yang sama untuk cutoff yang dipilih dalam memprediksi kontrol gula darah pada pasien DM.…”

Continuous glucose monitoring identifies relationship between optimized glycemic control and post-discharge acute care facility needs

“…Hyperglycemia is an independent risk factor for poor outcomes in those with and without diabetes, generally [ 3 ]. Many, but not all trials in regard to hyperglycemia show benefits of glucose control [ 3 ]. CGM may better assist health care providers in managing glycemic control in ICU patients and contribute to improved quality and safety.…”

“…CGM may better assist health care providers in managing glycemic control in ICU patients and contribute to improved quality and safety. Maintaining normoglycemic control within this population, with or without diabetes, is of paramount importance [ 3 , 5 , 6 ]. Additionally, subcutaneous CGM is safe in critically ill patients in terms of hypoglycemia [ 6 ].…”

“…Studies have shown a reduction in mortality, morbidity, and length of stay with adequate glycemic control in ICU patients [ 1 , 2 ]. Hyperglycemia is frequent in hospitalized patients, and it is an independent risk factor for adverse outcomes, even if the patient is not diabetic [ 3 ]. There are subsequent studies that have tempered these claims and demonstrated that glycemic control that is too tight may be undesirable [ 4 ].…”