Abstract
Background: Maintenance of appropriate capillary blood glucose in cardiovascular surgery patients has been associated with improved outcomes, including lower mortality. Interpatient variability in insulin resistance can make management difficult, leading to unexpected episodes of hypoglycemia and hyperglycemia. To improve postoperative glucose control at our institution, a patient-specific insulin-resistanceguided (IRG) protocol was developed. Methods: Prospective data were gathered on 100 consecutive cardiovascular surgery patients managed with our standard insulin infusion protocol and 100 patients managed using the IRG protocol. Clinical characteristics and glycemic indices were analyzed for the two groups. Primary endpoints included (1) percentage of time spent in the target range, (2) number of hypoglycemic and hyperglycemic episodes, (3) time to achievement of target blood glucose, and (4) the total daily dose of insulin required. Results: The IRG protocol resulted in significant improvements, including increased percentage of time spent in the normoglycemic range (82.5% versus 65.8%, p <0.001), reduced rate of hypoglycemic episodes (0.12 versus 0.99, p <0.01), reduced rate of hyperglycemic episodes (capillary blood glucose >126 mg/dL: 4.8 versus 8.2, p <0.01), and a reduced time to the first measurement in the target range. Total daily dose of insulin was mildly increased, but failed to reach statistical significance (92.48 versus 82.64 units, p = 0.32). Conclusions: Use of the IRG protocol led to improved glycemic indices while reducing episodes of hypoglycemia in both diabetic and nondiabetic patients. The ability to adjust a patient's insulin dosing based upon factors related to their insulin resistance results in improved blood glucose control and safety in cardiovascular surgery patients.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1818-1823 |
| Number of pages | 6 |
| Journal | Annals of Thoracic Surgery |
| Volume | 90 |
| Issue number | 6 |
| DOIs | |
| State | Published - Dec 2010 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
- Pulmonary and Respiratory Medicine
Cite this
Patient-specific insulin-resistanceguided infusion improves glycemic control in cardiac surgery. / Caddell, Kirk A.; Komanapalli, Christopher B.; Slater, Matthew; Hagg, Daniel; Tibayan, Frederick (Fred); Smith, Stephen; Ahmann, Andrew; Guyton, Steven W.; Song, Howard.
In: Annals of Thoracic Surgery, Vol. 90, No. 6, 12.2010, p. 1818-1823.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Patient-specific insulin-resistanceguided infusion improves glycemic control in cardiac surgery
AU - Caddell, Kirk A.
AU - Komanapalli, Christopher B.
AU - Slater, Matthew
AU - Hagg, Daniel
AU - Tibayan, Frederick (Fred)
AU - Smith, Stephen
AU - Ahmann, Andrew
AU - Guyton, Steven W.
AU - Song, Howard
PY - 2010/12
Y1 - 2010/12
N2 - Background: Maintenance of appropriate capillary blood glucose in cardiovascular surgery patients has been associated with improved outcomes, including lower mortality. Interpatient variability in insulin resistance can make management difficult, leading to unexpected episodes of hypoglycemia and hyperglycemia. To improve postoperative glucose control at our institution, a patient-specific insulin-resistanceguided (IRG) protocol was developed. Methods: Prospective data were gathered on 100 consecutive cardiovascular surgery patients managed with our standard insulin infusion protocol and 100 patients managed using the IRG protocol. Clinical characteristics and glycemic indices were analyzed for the two groups. Primary endpoints included (1) percentage of time spent in the target range, (2) number of hypoglycemic and hyperglycemic episodes, (3) time to achievement of target blood glucose, and (4) the total daily dose of insulin required. Results: The IRG protocol resulted in significant improvements, including increased percentage of time spent in the normoglycemic range (82.5% versus 65.8%, p <0.001), reduced rate of hypoglycemic episodes (0.12 versus 0.99, p <0.01), reduced rate of hyperglycemic episodes (capillary blood glucose >126 mg/dL: 4.8 versus 8.2, p <0.01), and a reduced time to the first measurement in the target range. Total daily dose of insulin was mildly increased, but failed to reach statistical significance (92.48 versus 82.64 units, p = 0.32). Conclusions: Use of the IRG protocol led to improved glycemic indices while reducing episodes of hypoglycemia in both diabetic and nondiabetic patients. The ability to adjust a patient's insulin dosing based upon factors related to their insulin resistance results in improved blood glucose control and safety in cardiovascular surgery patients.
AB - Background: Maintenance of appropriate capillary blood glucose in cardiovascular surgery patients has been associated with improved outcomes, including lower mortality. Interpatient variability in insulin resistance can make management difficult, leading to unexpected episodes of hypoglycemia and hyperglycemia. To improve postoperative glucose control at our institution, a patient-specific insulin-resistanceguided (IRG) protocol was developed. Methods: Prospective data were gathered on 100 consecutive cardiovascular surgery patients managed with our standard insulin infusion protocol and 100 patients managed using the IRG protocol. Clinical characteristics and glycemic indices were analyzed for the two groups. Primary endpoints included (1) percentage of time spent in the target range, (2) number of hypoglycemic and hyperglycemic episodes, (3) time to achievement of target blood glucose, and (4) the total daily dose of insulin required. Results: The IRG protocol resulted in significant improvements, including increased percentage of time spent in the normoglycemic range (82.5% versus 65.8%, p <0.001), reduced rate of hypoglycemic episodes (0.12 versus 0.99, p <0.01), reduced rate of hyperglycemic episodes (capillary blood glucose >126 mg/dL: 4.8 versus 8.2, p <0.01), and a reduced time to the first measurement in the target range. Total daily dose of insulin was mildly increased, but failed to reach statistical significance (92.48 versus 82.64 units, p = 0.32). Conclusions: Use of the IRG protocol led to improved glycemic indices while reducing episodes of hypoglycemia in both diabetic and nondiabetic patients. The ability to adjust a patient's insulin dosing based upon factors related to their insulin resistance results in improved blood glucose control and safety in cardiovascular surgery patients.
UR - http://www.scopus.com/inward/record.url?scp=78649424007&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78649424007&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2010.05.054
DO - 10.1016/j.athoracsur.2010.05.054
M3 - Article
C2 - 21095317
AN - SCOPUS:78649424007
VL - 90
SP - 1818
EP - 1823
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 6
ER -