Long-Acting Subcutaneously Administered Insulin for Glycemic Control Immediately After Cardiac Surgery |
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| Institution: | 1. Division of Endocrinology, Diabetes and Hypertension;2. Division of Cardiac Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts.;1. Department of Pathology, Harbor-UCLA Medical Center, 1000 West Carson Street, Torrance, CA 90502, USA;2. Terasaki Foundation Laboratory, 11570 West Olympic Boulevard, Los Angeles, CA 90064, USA;1. Complejo Hospitalario Universitario A Coruña, A Coruña, Spain;2. Instituto de Investigación Biomédica de A Coruña (INIBIC), A Coruña, Spain;3. Hospital Puerta de Hierro, Madrid, Spain;4. Hospital Marqués de Valdecilla, Santander, Spain;5. Hospital Doce de Octubre, Madrid, Spain;6. Hospital Clinic i Provincial, Barcelona, Spain;7. Hospital Universitario Politécnico La Fe. Valencia, Spain;8. Hospital Reina Sofía, Córdoba, Spain;9. Hospital Virgen del Rocío, Sevilla, Spain;10. Hospital Clínico Universitario de Valladolid, Valladolid, Spain;11. Hospital de Bellvitge, Hospitalet de Llobregat, Spain;12. Hospital Miguel Servet, Zaragoza, Spain;13. Hospital Gregorio Marañón, Madrid, Spain;14. Hospital Universitario Central de Asturias, Oviedo, Spain;15. Hospital Santa Creu i Sant Pau, Barcelona, Spain;p. Hospital Virgen de la Arrixaca, Murcia, Spain;q. Instituto Universitario de Ciencias de la Salud, Universidad de A Coruña, A Coruña, Spain;1. Department of Neonatology, Beth Israel Deaconess Medical Center, Boston, MA;2. Department of Neonatology, Harvard Medical School, Boston, MA;1. School of Pharmacy, Northeastern University, Boston, MA;2. Maine Medical Center, Portland, ME;3. College of Pharmacy, University of Texas, Austin, TX;4. Department of Health Sciences, Northeastern University, Boston, MA |
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| Abstract: | ObjectiveTo test the hypothesis that subcutaneous administration of basal insulin begun immediately after cardiac surgery can decrease the need for insulin infusion in patients without diabetes and save nursing time.MethodsAfter cardiac surgery, 36 adult patients without diabetes were randomly assigned to receive either standard treatment (control group) or insulin glargine once daily in addition to standard treatment (basal insulin group). Standard treatment included blood glucose measurements every 1 to 4 hours and intermittent insulin infusion to maintain blood glucose levels between 100 and 150 mg/dL. The study period lasted up to 72 hours.ResultsThere were no differences in demographics or baseline laboratory characteristics of the 2 study groups. Mean daily blood glucose levels were lower in the basal insulin group in comparison with the control group, but the difference was not statistically significant (129.3 ± 9.4 mg/ dL versus 132.6 ± 7.3 mg/dL; P = .25). The mean duration of insulin infusion was significantly shorter in the basal insulin group than in the control group (16.3 ± 10.7 hours versus 26.6 ± 17.3 hours; P = .04). Nurses tested blood glucose a mean of 8.3 ± 3.5 times per patient per day in the basal insulin group and 12.0 ± 4.7 times per patient per day in the control group (P = .01). There was no occurrence of hypoglycemia (blood glucose level < 60 mg/dL) in either group.ConclusionOnce-daily insulin glargine is safe and may decrease the duration of insulin infusion and reduce nursing time in patients without diabetes who have hyperglycemia after cardiac surgery. (Endocr Pract. 2011;17: 558-562) |
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