Association of Time in Blood Glucose Range with Outcomes Following Cardiac Surgery

Overview

Journal BMC Anesthesiol

Publisher Biomed Central

Specialty Anesthesiology

Date 2015 Feb 12

PMID 25670921

Citations 28

Authors

Amr S Omar

Ahmed Salama

Mahmoud Allam

Yasser Elgohary

Shaban Mohammed

Alejandro Kohn Tuli

Rajvir Singh

Affiliations

Soon will be listed here.

Abstract

Background: The importance of optimal postoperative glycemic control in cardiac patients remains unclear. Various glycemic targets have been prescribed to reduce wound infection and overall mortality rates.

Aim Of The Work: To assess glucose control, as determined by time in range (TIR), in patients with glycemic targets of 6.0 to 8.1 mmol/L, and to determine factors related to poor control.

Methods: This prospective descriptive study evaluated 227 consecutive patients, 100 with and 127 without diabetes, after cardiac surgery. Patients received insulin to target glucose concentrations of 6.0 to 8.1 mmol/L. Data analyzed included patient age, gender, race, Euro score, cardiopulmonary bypass time (CPB), aortic cross clamp time (ACC), length of ventilation, stay in the intensive care unit (ICU) and stay in the hospital. Patients were divided into two groups, those who maintained > 80% and < 80% TIR. Outcome variables were compared in diabetics and non-diabetics.

Results: Patients with >80% and <80% TIR were matched in age, sex, gender, and Euro score. Failure to maintain target glycemia was significantly more frequent in diabetics (p = 0.001), in patients with glycated hemoglobin (HbA1c) > 8% (p = 0.0001), and in patients taking dopamine (p = 0.04) and adrenaline (p = 0.05). Times of CPB and ACC, length of stay in the ICU and ventilation were significantly higher in patients with TIR <80% than >80%. Rates of hypoglycemia, acute kidney injury, and in-hospital mortality were similar in the two groups, although the incidence of wound infection was higher in patients with TIR <80%. Both diabetics and non-diabetics with low TIR had poorer outcomes, as shown by length of stay and POAF. No significant differences were found between the two ethnic groups (Arabs and Asians).

Conclusion: Patients with >80% TIR, whether or not diabetics, had better outcomes than those with <80% TIR, as determined by wound infection, lengths of ventilation and ICU stay. Additionally, they were not subject to frequent hypoglycemic events. Preoperatively high HbA1C is likely a good predictor of poor glycemic control.

Citing Articles

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Rationale and strategies for improving glycaemic control in diabetic patients undergoing cardiac surgery: a narrative review.

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Machine Learning-Based Time in Patterns for Blood Glucose Fluctuation Pattern Recognition in Type 1 Diabetes Management: Development and Validation Study.

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References

Ouattara A, Lecomte P, Le Manach Y, Landi M, Jacqueminet S, Platonov I . Poor intraoperative blood glucose control is associated with a worsened hospital outcome after cardiac surgery in diabetic patients. Anesthesiology. 2005; 103(4):687-94. DOI: 10.1097/00000542-200510000-00006. View

Krinsley J, Meyfroidt G, Van den Berghe G, Egi M, Bellomo R . The impact of premorbid diabetic status on the relationship between the three domains of glycemic control and mortality in critically ill patients. Curr Opin Clin Nutr Metab Care. 2012; 15(2):151-60. DOI: 10.1097/MCO.0b013e32834f0009. View

Halkos M, Lattouf O, Puskas J, Kilgo P, Cooper W, Morris C . Elevated preoperative hemoglobin A1c level is associated with reduced long-term survival after coronary artery bypass surgery. Ann Thorac Surg. 2008; 86(5):1431-7. DOI: 10.1016/j.athoracsur.2008.06.078. View

Furnary A, Gao G, Grunkemeier G, Wu Y, Zerr K, Bookin S . Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003; 125(5):1007-21. DOI: 10.1067/mtc.2003.181. View

Hargraves J . Glycemic control in cardiac surgery: implementing an evidence-based insulin infusion protocol. Am J Crit Care. 2014; 23(3):250-8. DOI: 10.4037/ajcc2014236. View

Lehot J, Piriz H, Villard J, Cohen R, Guidollet J . Glucose homeostasis. Comparison between hypothermic and normothermic cardiopulmonary bypass. Chest. 1992; 102(1):106-11. DOI: 10.1378/chest.102.1.106. View

Ehtisham S, Crabtree N, Clark P, Shaw N, Barrett T . Ethnic differences in insulin resistance and body composition in United Kingdom adolescents. J Clin Endocrinol Metab. 2005; 90(7):3963-9. DOI: 10.1210/jc.2004-2001. View

Haga K, McClymont K, Clarke S, Grounds R, Ng K, Glyde D . The effect of tight glycaemic control, during and after cardiac surgery, on patient mortality and morbidity: A systematic review and meta-analysis. J Cardiothorac Surg. 2011; 6:3. PMC: 3023693. DOI: 10.1186/1749-8090-6-3. View

Jacobi J, Bircher N, Krinsley J, Agus M, Braithwaite S, Deutschman C . Guidelines for the use of an insulin infusion for the management of hyperglycemia in critically ill patients. Crit Care Med. 2012; 40(12):3251-76. DOI: 10.1097/CCM.0b013e3182653269. View

10.

Lazar H, Chipkin S, Fitzgerald C, Bao Y, Cabral H, Apstein C . Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation. 2004; 109(12):1497-502. DOI: 10.1161/01.CIR.0000121747.71054.79. View

11.

Krinsley J . Association between hyperglycemia and increased hospital mortality in a heterogeneous population of critically ill patients. Mayo Clin Proc. 2003; 78(12):1471-8. DOI: 10.4065/78.12.1471. View

12.

de Azevedo J, Azevedo R, Lucena L, Costa N, Silva W . Impact of glycemic control on the incidence of acute kidney injury in critically ill patients: a comparison of two strategies using the RIFLE criteria. Clinics (Sao Paulo). 2010; 65(8):769-73. PMC: 2933117. DOI: 10.1590/s1807-59322010000800005. View

13.

Leibowitz G, Raizman E, Brezis M, Glaser B, Raz I, Shapira O . Effects of moderate intensity glycemic control after cardiac surgery. Ann Thorac Surg. 2010; 90(6):1825-32. DOI: 10.1016/j.athoracsur.2010.07.063. View

14.

Lazar H, McDonnell M, Chipkin S, Fitzgerald C, Bliss C, Cabral H . Effects of aggressive versus moderate glycemic control on clinical outcomes in diabetic coronary artery bypass graft patients. Ann Surg. 2011; 254(3):458-63. DOI: 10.1097/SLA.0b013e31822c5d78. View

15.

Bhamidipati C, LaPar D, Stukenborg G, Morrison C, Kern J, Kron I . Superiority of moderate control of hyperglycemia to tight control in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2010; 141(2):543-51. PMC: 3099050. DOI: 10.1016/j.jtcvs.2010.10.005. View

16.

Macheda M, Rogers S, Best J . Molecular and cellular regulation of glucose transporter (GLUT) proteins in cancer. J Cell Physiol. 2004; 202(3):654-62. DOI: 10.1002/jcp.20166. View

17.

Rady M, Johnson D, Patel B, Larson J, Helmers R . Influence of individual characteristics on outcome of glycemic control in intensive care unit patients with or without diabetes mellitus. Mayo Clin Proc. 2005; 80(12):1558-67. DOI: 10.4065/80.12.1558. View

18.

Falciglia M, Freyberg R, Almenoff P, DAlessio D, Render M . Hyperglycemia-related mortality in critically ill patients varies with admission diagnosis. Crit Care Med. 2009; 37(12):3001-9. PMC: 2905804. DOI: 10.1097/CCM.0b013e3181b083f7. View

19.

Pezzella A, Holmes S, Pritchard G, Speir A, Ad N . Impact of perioperative glycemic control strategy on patient survival after coronary bypass surgery. Ann Thorac Surg. 2014; 98(4):1281-5. DOI: 10.1016/j.athoracsur.2014.05.067. View

20.

Furnary A, Wu Y, Bookin S . Effect of hyperglycemia and continuous intravenous insulin infusions on outcomes of cardiac surgical procedures: the Portland Diabetic Project. Endocr Pract. 2004; 10 Suppl 2:21-33. DOI: 10.4158/EP.10.S2.21. View