The effect of insulin therapy algorithms on blood glucose levels in patients following cardiac surgery: a systematic review

Higgs, Megan; Fernandez, Ritin

doi:10.11124/01938924-201513050-00013

Cited by 9 publications

(8 citation statements)

References 29 publications

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“…30 While studies related to this have mentioned the use of constant insulin infusion for glycemic control pre-and post-operative, other studies have shown that this may increase the risk of MI and other adverse events. 16,19 The EMEA states that insulin has a neutral effect and, in some cases, a beneficial effect but we recommend further research into the use of insulin as the FDA advises caution in certain patient populations. 39,40 There is also a lack of clarity in the guidance for intensive care unit glucose targets, which suggests a need for larger studies to better provide a gold standard reference range.…”

Section: Glycemic Controlmentioning

confidence: 99%

“…15 A summary of different ADM classes' outcomes from various studies is represented in Table 2. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32] A systematic review compared the effects between ADMs on different cardiovascular outcomes, such as mortality, HDL/LDL cholesterol levels, systolic blood pressure, and triglyceride. Bolen et al compared oral agents-thiazolidinediones, biguanides, meglitinides, and alpha-glucosidase inhibitors in adults with type 2 diabetes.…”

Section: Mortalitymentioning

confidence: 99%

“…This can be adopted into practice when insulin is used to control blood glucose levels. 19 Sulfonylureas were identified to have a significantly higher hospital mortality of almost 3 times in a study that observed the outcomes of patients undergoing direct coronary angioplasty for acute MI. 23 In a multi-center trial, Pioglitazone as an add on to sulfonylureas was found to have no additional benefits of reducing major cardiac events.…”

Section: Mortalitymentioning

confidence: 99%

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Diabetic Control Agents and Their Impact on Cardiac Surgery Patients: A Clinical Overview

O’Neill

Leung

Visser

et al. 2020

J Cardiovasc Pharmacol Ther

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Chronic hyperglycemia is associated with poor cardiovascular surgical outcomes due to microvascular and macrovascular complications. This is a major concern as over one third of cardiovascular surgical patients have diabetes mellitus which greatly increases their risk of experiencing adverse cardiovascular events. A literature review was performed to identify articles discussing the effects of anti-diabetic medications (ADMs) on cardiovascular outcomes and surgical mortality and morbidity rates. Optimizing perioperative glucose levels remains a key factor in producing good surgical outcomes. In addition, recognizing gender differences, increasing patient satisfaction, and implementing dedicated diabetic teams all improve surgical mortality and morbidity rates in the diabetic population.

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Section: Glycemic Controlmentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

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Diabetic Control Agents and Their Impact on Cardiac Surgery Patients: A Clinical Overview

O’Neill

Leung

Visser

et al. 2020

J Cardiovasc Pharmacol Ther

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“…It has been found that the incidence of hyperglycemia after cardiac surgery is very high (stress induced hyperglycemia), and it occurs almost universally after cardiac surgeries, regardless of whether a person is diabetic or not [ 2 ]. The mechanisms by which hyperglycemia affect outcomes could be related to suppressive effects on immune function and an associated increased risk of infection, endothelial damage, hepatocyte mitochondrial damage, and potentiation of tissue ischemia due to acidosis or inflammation [ 3 – 5 ].…”

Section: Introductionmentioning

confidence: 99%

Automated versus conventional perioperative glycemic control in adult diabetic patients undergoing open heart surgery

et al. 2022

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Background Intraoperative glycemic variability is associated with increased risks of mortality and morbidity and an increased incidence of hyperglycemia after cardiac surgery. Accordingly, clinicians tend to use a tight glucose control to maintain perioperative blood glucose levels and therefore the need to develop a less laborious automated glucose control system is important especially in diabetic patients at a higher risk of developing complications. Methods Patients, aged between 40 and 75 years old, undergoing open heart surgery were randomized to either an automated protocol (experimental) or to the conventional technique at our institution (control). Results We showed that the percentage of patients maintained between 7.8–10 mmol.l−1 was not statistically different between the two groups, however, through an additional analysis, we showed that the proportion of patients whose glucose levels maintained between a safety level of 6.7–10 mmol.l−1 was significantly higher in the experimental group compared to control group, 14 (26.7%) vs 5 (17.2%) P = 0.025. In addition, the percentage of patients who had at least one intraoperative hyperglycemic event was significantly higher in the control group compared to the experimental group, 17 (58.6%) vs 5 (16.7%), P < 0.001 with no hypoglycemic events in the experimental group compared to two events in the control group. We also showed that longer surgeries can benefit more from using the automated glucose control system, particularly surgeries lasting more than 210 min. Conclusion We concluded that the automated glucose control pump in diabetic patients undergoing open heart surgeries maintained most of the patients within a predefined glucose range with a very low incidence of hyperglycemic events and no incidence of hypoglycemic events. Trial registration Registered with clinicaltrials.gov (NCT #NCT03314272, Principal investigator Roland Kaddoum, date of registration: 19/10/2017).

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“…Glycaemic control among patients in intensive care units (ICU) has received considerable attention for the past 15 years (Clain et al., 2015). Hyperglycaemia is directly correlated with increased mortality or morbidity (Bar‐Or et al., 2019) and is an important factor in predicting acute myocardial infarction, infection, length of ICU confinement and mortality rate for patients undergoing open heart surgery (OHS) (Frioud et al., 2010; Girish et al., 2014; Higgs & Fernandez, 2015).…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of blood glucose control protocol for open heart surgery patients

Yoo

Suh

Shim

2020

Journal of Advanced Nursing

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Aims To evaluate the effectiveness of a tailored blood glucose control protocol for postoperative cardiac surgery patients treated in intensive care. Design Retrospective study. Methods Data for the control group (non‐tailored protocol) were collected from medical records at a tertiary hospital in Seoul, Korea between April–July 2015. Data for the experimental group (tailored protocol) were obtained from medical records between April–July 2016. After adjusting the target blood glucose range, eliminating single‐dose insulin administration and extending the blood glucose measurement time interval, data for blood glucose measurements, time for reaching and maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments for the experimental group were collected. Results In the experimental group (where the target blood glucose rate was increased) the hypoglycaemia rate and the variation in blood glucose decreased significantly compared with the control group. In particular, the experimental group maintained relatively stable blood glucose levels by retaining a small variation range in glucose, regardless of the presence of diabetes. Time required for maintaining target blood glucose, mean number of daily blood glucose measurements and insulin dose adjustments per patient decreased. Conclusion The tailored protocol contributes to the safe and effective control of blood glucose in critical care patients after cardiac surgery and to the efficiency of nurses administering it. Impact This study has two significant impacts. The application of the tailored protocol has a positive impact on patients’ blood glucose management, a critical component of treatment for postoperative cardiac patients in intensive care units. It also has a positive impact on the efficiency of nurses applying it. The results of this study are thus expected to facilitate successful implementation of clinical protocols for critical care after heart surgery.

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The effect of insulin therapy algorithms on blood glucose levels in patients following cardiac surgery: a systematic review

Cited by 9 publications

References 29 publications

Diabetic Control Agents and Their Impact on Cardiac Surgery Patients: A Clinical Overview

Diabetic Control Agents and Their Impact on Cardiac Surgery Patients: A Clinical Overview

Automated versus conventional perioperative glycemic control in adult diabetic patients undergoing open heart surgery

Effectiveness of blood glucose control protocol for open heart surgery patients

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