Glycemic Control with use of Insulin Glargine after Cardiothoracic Surgery: A Retrospective Study |
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| Institution: | 1. Endocrinology and Metabolism Institute, Cleveland Clinic;2. Department of Epidemiology and Biostatistics, Case Western Reserve University School of Medicine;3. Anesthesia Institute, Cleveland Clinic;4. Quantitative Health Institute, Cleveland Clinic, Cleveland, Ohio;1. Department of Internal Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania;2. Department of Endocrinology and Metabolism, Lehigh Valley Health Network, Allentown, Pennsylvania;1. Division of Endocrinology, \"V. Fazzi\" Hospital, Lecce, Italy;2. Department of Pathology, IRCCS Arcispedale Santa Maria Nuova, Reggio Emilia, Italy;3. Department of Biomedical Sciences and Human Oncology, University of Turin, Turin, Italy;4. Endocrine Unit & Thyroid Diseases Center, IRCCS-Arcispedale Santa Maria Nuova, Reggio Emilia, Italy;1. Servizio di Diabetologia, Policlinico Gemelli, Universita Cattolica, Rome, Italy;2. Global Research & Development, Novo Nordisk A/S, Søborg, Denmark;3. Practice for Internal Medicine and Diabetology, Frankfurt, Germany;4. Endocrinology, Diabetes, & Metabolism, Rambam Medical Centre and Faculty of Medicine, Technion, Haifa, Israel;5. University of Miami Miller School of Medicine, Miami, Florida;6. Department of Biostatistics & Epidemiology, Novo Nordisk A/S, Søborg, Denmark.;1. Section of Cardiology, Department of Medicine, Baylor College of Medicine, Houston, Texas;2. Department of Internal Medicine, Einstein Medical Center, Philadelphia, Pennsylvania;3. Division of Cardiovascular Medicine, Henry Ford Hospital, Detroit, Michigan;4. Department of Internal Medicine, Lincoln Medical Center, New York, New York;5. Department of Cardiovascular Medicine, Ain Shams University, Cairo, Egypt;6. Department of Medicine, Weill Cornell Medicine-Qatar, Doha, Qatar;1. Department of Medicine;2. Division of Endocrinology and Metabolism, University of California, San Francisco, California;3. Division of Gastroenterology and Hepatology, Weill Cornell Medical College, New York, New York;4. Division of Gastroenterology, University of California, San Francisco, California |
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| Abstract: | ObjectivePerioperative glycemic control in critically ill cardiothoracic surgery patients may improve postsurgical outcomes. The objective of the study was to compare outcomes before and after the implementation of a protocol using subcutaneous (SC) glargine at transition from intravenous insulin infusion (IVII).MethodsIn August 2006, the Cleveland Clinic began using glargine and supplemental rapid-acting sliding scale insulin (SSI) at transition from IVII (glargine-SSI group). Before August 2006, only supplemental insulin was used (SSI-only group). The primary outcome was first blood glucose (BG1) after discontinuation of IVII. Secondary outcomes included the absolute difference between the last glucose before discontinuation of IVII (BG0) and BG1, mean glucose in the first 24 hours after discontinuation of IVII (BG24), need for SSI, and hypoglycemia.ResultsMean BG0, BG1, and BG24, and the difference between BG1 and BG0 and between BG24 and BG0 were not significantly different between groups. Diabetes mellitus (DM) patients who had received glargine had a lower mean difference between BG1 and BG0 and a lower mean BG24 than those who had not received glargine (14.6 mg/dL vs. 33.1 mg/dL; P = .20, and 163.8 mg/dL vs. 177.9 mg/dL; P = .29, respectively). A higher proportion of DM patients needed SSI than did non-DM patients (82% vs. 36%; P<.001).ConclusionGlargine administered at the cessation of IVII enabled less SSI coverage in diabetic patients subsequent to transition from IVII. However, there was no significant difference in BG control between the glargine-SSI and SSI-only groups. Prospective studies involving more patients are needed to show possible clinically significant benefits of this intervention. (Endocr Pract. 2013;19:485-493) |
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