The Society of Thoracic Surgeons Practice Guideline Series: Blood Glucose Management During Adult Cardiac Surgery

Management of hospitalized type 2 diabetes mellitus patients

“…If the patients were treated with insulin previously, they will need insulin in the perioperative period. [4,51] Because basal insulin is for period between meals, on the day of surgery, it must be administered even if the patients are not going to eat. Moreover, we should prescribe a correctional dose of regular or rapid-acting insulin.…”

“…In some situations, such as patients with difficult control, intravenous insulin infusion is a good option, although it depends on the accessibility and possibility of patients monitoring. [50,51] Postoperatively, basal bolus regimen is better than sliding-scale insulin to control glucose. If patients do not eat, we must only prescribe basal insulin with a correctional dose of regular or rapid-acting insulin; when patients start to eat, we must administer basal insulin plus nutritional insulin in the meals plus correctional dose.…”

Perioperative catabolism

“…[85][86][87][88][89] It is particularly interesting that most ''glycemic control studies'' after Leuven-I were unable to establish and preserve a normal blood glucose level. 74,76,78 Therefore, the conclusions that studies failing to reach this target reported regarding the clinical benefits of normoglycemia are questionable.…”

Glycemic Control in Cardiac Surgery

“…From this point of view, we should consider simultaneously the combined and independent clinical impact of glycemia's sudden fluctuations, glycemia temporal trends, and glycemia variability during hospitalization. In this way of thought, in a study including over 7,000 critically ill patients was demonstrated that the standard deviation of glucose concentration is a significant independent predictor of ICU and hospital mortality (78 (80,81). The next section is related with recommendations about management of hyperglycemia in both patients with and without diabetes undergoing cardiac surgical, and the procedures that should be taken into account during the perioperative period, obtained from the Society of Thoracic Surgeons (STS) Practice Guideline series (81), which is derived in turns from evidence-based recommendations.…”