Comparison of glycemic and surgical outcomes after change in glycemic targets in cardiac surgery patients. Journal Article

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Authors: Mulla, I; Schmidt, K; Cashy, J; Wallia, A; Andrei, AC; Johnson Oakes, D; Aleppo, G; Li, C; Grady, KL; McGee, E; Molitch, ME
Article Title: Comparison of glycemic and surgical outcomes after change in glycemic targets in cardiac surgery patients.
Abstract: OBJECTIVE: To compare perioperative glycemic and long-term surgical outcomes in patients undergoing cardiac surgery before and after the recommended 2009 changes in inpatient glycemic targets. RESEARCH DESIGN AND METHODS: We performed a retrospective review of patients who underwent cardiac surgery between 4 September 2007 and 30 April 2011. Comparison was made of blood glucose (BG) outcomes 3 days after surgery, and 30-day cardiac outcomes before and after a change in insulin protocol that took place on 1 September 2009, which consisted of raising the glycemic targets during intravenous insulin infusions from 80-110 mg/dL (80-110 group) to 110-140 mg/dL (110-140 group). RESULTS: When compared with the 80-110 group (n = 667), the 110-140 group (n = 658) had higher mean postoperative BG levels during the intravenous insulin infusion (141 ± 15 vs. 121 ± 15 mg/dL, P 0.001) and the subcutaneous insulin period (134 ± 24 vs. 130 ± 23 mg/dL, P 0.001), and for 3 days postoperatively (141 ± 17 vs. 127 ± 15 mg/dL, P 0.001). Fewer patients in the 110-140 mg/dL group experienced moderate hypoglycemia (BG 70 mg/dL) (177 vs. 73, P = 0.04). Severe hypoglycemia (BG 40 mg/dL) occurred in only one patient in the 80-110 group and three patients in the 110-140 group. There were no significant differences in mortality or surgical complication rates (with the exception of reintubation) between the groups. CONCLUSIONS: The higher glycemic target of 110-140 mg/dL resulted in similar mean glucose values, with significantly less hypoglycemia and no significant differences in mortality/morbidity compared with the more strict target of 80-110 mg/dL.
Journal Title: Diabetes care
ISSN: 1935-5548; 0149-5992
Publisher: Unknown  
Date Published: 2014
LUC Authors
  1. Edwin McGee, Jr.
    21 McGee
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