Effectiveness, safety and feasibility of an evidence-based insulin infusion protocol targeting moderate glycaemic control in intensive cardiac care units

Avanzini, Fausto; Marelli, Giuseppe; Saltafossi, Donata; Longhi, Chiara; Carbone, Stefania; Carlino, Liliana; Planca, E; Vilei, V.; Roncaglioni, Maria Carla; Riva, Emma

doi:10.1177/2048872615574110

Cited by 3 publications

(2 citation statements)

References 37 publications

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“…Furthermore, current standard IV insulin protocols also require hourly BG testing. 45,46 While continuous glucose monitoring, either SC or intravascular are not current options in the inpatient setting, if these tools ever become available the ability to control glycemia should become less burdensome. [47][48][49][50][51] Additional limitations of our study are the small cohort and the lack of a control arm.…”

Section: Discussionmentioning

confidence: 99%

Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

Espina

Jenkins

Taylor

et al. 2016

Bone Marrow Transplant

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Allogeneic hematopoietic cell transplantation (HCT) is a potentially curative treatment for patients with hematological malignancies. However, is associated with substantial rates of morbidity and mortality. We and others have shown that malglycemia is associated with adverse transplant outcome. Therefore, improving glycemic control may improve transplant outcome. In this prospective study we evaluated the feasibility of using Glucommander (a Computer-Guided Glucose Management System; CGGM) in order to achieve improved glucose control in hospitalized HCT patients. Nineteen adult patients contributed 21 separate instances on CGGM. Patients were on CGGM for a median of 43 h. Median initial blood glucose (BG) on CGGM was 244 mg/dL, and patients on 20 study instances reached the study BG target of 100-140 mg/dL after a median of 6 h. After BG reached the target range, the median average BG level per patient was 124 mg/dL. Six patients had a total of 10 events of BG o 70 mg/dL (0.9% of BG measurements), and no patients experienced BG level o 40 mg/dL. The total estimated duration of BG o 70 mg/dL was 3 h (0.2% of the total CGGM time). In conclusion, our study demonstrates that stringent BG control in HCT patients using CGGM is feasible.

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Section: Discussionmentioning

confidence: 99%

Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

Espina

Jenkins

Taylor

et al. 2016

Bone Marrow Transplant

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“…A relatively tight glucose level (4.4–6.1 mmol/L) was initially recommended to reduce short-term adverse events in hospitalized diabetic patients after CABG [ 3 ]. However, an increasing number of studies have shown that tight glucose control may not be as beneficial as originally thought [ 4 , 5 ], particularly in patients undergoing On-Pump CABG. Blood glucose fluctuations were more common in patients with strict blood glucose control, resulting in worse outcomes [ 6 ].…”

Section: Introductionmentioning

confidence: 99%

Effect of glycemic control and glucose fluctuation on in-hospital adverse outcomes after on-pump coronary artery bypass grafting in patients with diabetes: a retrospective study

You

Hou

Zhang

et al. 2023

Diabetol Metab Syndr

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Background The optimal glycemic control level in diabetic patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (On-Pump) remains unclear. Therefore, this study aimed to investigate the effect of different blood glucose control levels and glucose fluctuations on in-hospital adverse outcomes in diabetic patients undergoing on-pump CABG. Method A total of 3918 patients with diabetes undergoing CABG were reviewed in this study. A total of 1638 patients were eligible for inclusion and were categorized into strict, moderate and liberal glucose control groups based on post-operative mean blood glucose control levels of < 7.8 mmol/L, from 7.8 to 9.9 mmol/L and ≥ 10.0 mmoL/L, respectively. The primary endpoint was defined as a composite endpoint including in-hospital all-cause mortality and major cardiovascular complications. The secondary endpoint was defined as major cardiovascular complications including acute myocardial infarction, strokes and acute kidney injuries. To determine the associations between blood glucose fluctuations and adverse outcomes, patients with different glycemic control levels were further divided into subgroups according to whether the largest amplitude of glycemic excursion (LAGE) was ≥ 4.4 mmol/L or not. Results A total of 126 (7.7%) patients had a composite endpoint. Compared with moderate control, strict glucose control was associated with an increased risk of the primary endpoint (adjusted OR = 2.22, 95% CI 1.18–4.15, p = 0.01) and the secondary endpoint (adjusted OR = 1.95, 95% CI 1.01–3.77, p = 0.049). Furthermore, LAGE ≥ 4.4 mmol/L was significantly associated with the primary endpoint (adjusted OR = 1.67, 95% CI 1.12–2.50, p = 0.01) and the secondary endpoint (adjusted OR = 1.75, 95% CI 1.17–2.62, p = 0.01),respectively. Patients with LAGE ≥ 4.4 mmol/L had significantly higher rates of the composite endpoint and major vascular complications in both the strict-control (the primary endpoint, 66.7% vs 12.4%, p = 0.034, the secondary endpoint, 66.7% vs 10.3%, p = 0.03) and moderate-control groups (the primary endpoint, 10.2% vs 6.0%, p = 0.03, the secondary endpoint, 10.2% vs 5.8%, p = 0.02). Conclusions After On-Pump CABG patients with diabetes, strict glucose control (< 7.8 mmol/L) and relatively large glucose fluctuations (LAGE ≥ 4.4 mmol/L) were independently associated with in-hospital adverse outcomes.

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GlucoSTRESS - A project to optimize glycemic control in a level C (III) Portuguese intensive care unit

et al. 2021

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Effectiveness, safety and feasibility of an evidence-based insulin infusion protocol targeting moderate glycaemic control in intensive cardiac care units

Cited by 3 publications

References 37 publications

Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

Blood glucose control using a computer-guided glucose management system in allogeneic hematopoietic cell transplant recipients

Effect of glycemic control and glucose fluctuation on in-hospital adverse outcomes after on-pump coronary artery bypass grafting in patients with diabetes: a retrospective study

GlucoSTRESS - A project to optimize glycemic control in a level C (III) Portuguese intensive care unit

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