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Strict glycemic targets should be 'abandoned' for patients undergoing cardiac surgery
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Patients undergoing cardiac surgery showed similar mean perioperative glucose values but improved hypoglycemia rates after recommended changes that relaxed inpatient glycemic targets, according to research published in Diabetes Care.
“Our study demonstrated that the higher glycemic target of 110 mg/dL to 140 mg/dL compared to the older more stringent target of 80 mg/dL to 110 mg/dL for intravenous insulin, and 110 mg/dL to 180 mg/dL compared to 80 mg/dL to 150 mg/dL for subcutaneous insulin treatment, results in similar low cardiac surgical complications and mortality with significantly reduced hypoglycemia,” Mark E. Molitch, MD, of Northwestern University Feinberg School of Medicine, told Endocrine Today.
Molitch and colleagues conducted a retrospective review of electronic medical records from 1,325 patients who underwent cardiac surgery with postoperative glucose management from September 2007 to April 2011; surgery included coronary artery bypass grafting and/or cardiac valve repair or replacement.
The researchers compared blood glucose outcomes 3 days after surgery, along with 30-day cardiac outcomes before and after the insulin protocol change that took place on Sept. 1, 2009. It is currently recommended that glycemic targets during IV insulin infusions should be increased from a range of 80 to 110 mg/dL to a range of 140 to 180 mg/dL, with 110 to 140 mg/dL acceptable in centers experienced in such management, Molitch explained.
Preoperative blood glucose values were similar between patients in the 80 mg/dL to 110 mg/dL group (mean age, 63 years; n=667) and the 110 mg/dL to 140 mg/dL group (mean age, 64 years; n=658).
The 110 mg/dL to 140 mg/dL group demonstrated higher mean postoperative blood glucose levels during the IV insulin infusion than the 80 mg/dL to 110 mg/dL group (141 mg/dL vs. 121 mg/dL), during the subcutaneous insulin period (134 mg/dL vs. 130 mg/dL) and for 3 days postoperatively (141 mg/dL vs. 127 mg/dL; P<.001 for all).
Moderate hypoglycemia (blood glucose <70 mg/dL) was observed less in the 110 mg/dL to 140 mg/dL group than the 80 mg/dL to 110 mg/dL group (177 vs. 73; P=.04), and severe hypoglycemia (blood glucose <40 mg/dL) was experienced by one patient in the 80 mg/dL to 110 mg/dL group and three patients in the 110 mg/dL to 140 mg/dL group.
No significant differences between groups were observed in mortality or surgical complication rates, with the exception of reintubation.
“The clinical implications are that the old targets of 80 mg/dL to 110 mg/dL for intravenous insulin and 80 mg/dL to 150 mg/dL for subcutaneous insulin should be abandoned,” Molitch said. – by Allegra Tiver
Disclosure: The researchers report no relevant financial disclosures.
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