Perioperative Management of the Diabetic Patient Referred to Cardiac Surgery

Overview

Journal Braz J Cardiovasc Surg

Specialty Cardiology & Vascular Diseases

Date 2019 Jan 18

PMID 30652752

Citations 6

Authors

Camila Perez de Souza Arthur

Omar Asdrubal Vilca Mejia

Gisele Aparecida Lapenna

Carlos Manuel de Almeida Brandao

Luiz Augusto Ferreira Lisboa

Ricardo Ribeiro Dias

Luis Alberto Oliveira Dallan

Pablo Maria Alberto Pomerantzeff

Fabio B Jatene

Affiliations

Soon will be listed here.

Abstract

Currently there is a progressive increase in the prevalence of diabetes in a referred for cardiovascular surgery. Benefits of glycemic management (< 180 mg/dL) in diabetic patients compared to patients without diabetes in perioperative cardiac surgery. The purpose of this study is to present recommendations based on international evidence and adapted to our clinical practice for the perioperative management of hyperglycemia in adult patients with and without diabetes undergoing cardiovascular surgery. This update is based on the latest current literature derived from articles and guidelines regarding perioperative management of diabetic patients to cardiovascular surgery.

Citing Articles

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

Volpi S, Rajah T, Ali J J Thorac Dis. 2024; 16(11):8088-8102.

PMID: 39678873 PMC: 11635245. DOI: 10.21037/jtd-24-1112.

Cardiac interventions on total knee arthroplasty: a national inpatient sample-based analysis.

Mesarick E, Mounasamy V, Sambandam S Arch Orthop Trauma Surg. 2024; 144(5):2229-2238.

PMID: 38421413 DOI: 10.1007/s00402-024-05225-5.

Data-driven coaching to improve statewide outcomes in CABG: before and after interventional study.

Mejia O, Borgomoni G, de Freitas F, Furlan L, Orlandi B, Tiveron M Int J Surg. 2024; 110(5):2535-2544.

PMID: 38349204 PMC: 11093505. DOI: 10.1097/JS9.0000000000001153.

Effect of hyperglycemia treatment on complications rate after pediatric cardiac surgery.

Naghipour B, Bagerpour M, Shadvar K, Golzari S, Faridaalaee G J Cardiovasc Thorac Res. 2022; 14(1):18-22.

PMID: 35620747 PMC: 9106938. DOI: 10.34172/jcvtr.2022.05.

Teams, Rapid Recovery Protocols and Technology to Resume Cardiac Surgery in the COVID-19 Era.

Lima M, Borgomoni G, Mejia O Braz J Cardiovasc Surg. 2021; 36(3):822-824.

PMID: 34236825 PMC: 8641763. DOI: 10.21470/1678-9741-2021-0035.

References

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

Carson J, Scholz P, Chen A, Peterson E, Gold J, Schneider S . Diabetes mellitus increases short-term mortality and morbidity in patients undergoing coronary artery bypass graft surgery. J Am Coll Cardiol. 2002; 40(3):418-23. DOI: 10.1016/s0735-1097(02)01969-1. View

Ko S, Song K, Kim S, Lee J, Kim J, Shin J . Long-term effects of a structured intensive diabetes education programme (SIDEP) in patients with Type 2 diabetes mellitus--a 4-year follow-up study. Diabet Med. 2007; 24(1):55-62. DOI: 10.1111/j.1464-5491.2007.02013.x. View

Friedberg S, Lam Y, Blum J, Gregerman R . Insulin absorption: a major factor in apparent insulin resistance and the control of type 2 diabetes mellitus. Metabolism. 2006; 55(5):614-9. DOI: 10.1016/j.metabol.2005.12.004. View

Farkouh M, Domanski M, Sleeper L, Siami F, Dangas G, Mack M . Strategies for multivessel revascularization in patients with diabetes. N Engl J Med. 2012; 367(25):2375-84. DOI: 10.1056/NEJMoa1211585. View

Gandhi G, Nuttall G, Abel M, Mullany C, Schaff H, OBrien P . Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery: a randomized trial. Ann Intern Med. 2007; 146(4):233-43. DOI: 10.7326/0003-4819-146-4-200702200-00002. View

Doenst T, Wijeysundera D, Karkouti K, Zechner C, Maganti M, Rao V . Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2005; 130(4):1144. DOI: 10.1016/j.jtcvs.2005.05.049. View

Zerr K, Furnary A, Grunkemeier G, Bookin S, Kanhere V, Starr A . Glucose control lowers the risk of wound infection in diabetics after open heart operations. Ann Thorac Surg. 1997; 63(2):356-61. DOI: 10.1016/s0003-4975(96)01044-2. View

Butterworth J, Wagenknecht L, Legault C, Zaccaro D, Kon N, Hammon Jr J . Attempted control of hyperglycemia during cardiopulmonary bypass fails to improve neurologic or neurobehavioral outcomes in patients without diabetes mellitus undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2005; 130(5):1319. DOI: 10.1016/j.jtcvs.2005.02.049. View

10.

Braithwaite S, Godara H, Song H, Rock P . No patient left behind: evaluation and design of intravenous insulin infusion algorithms. Endocr Pract. 2006; 12 Suppl 3:72-8. DOI: 10.4158/EP.12.S3.72. View

11.

Raza S, Sabik 3rd J, Masabni K, Ainkaran P, Lytle B, Blackstone E . Surgical revascularization techniques that minimize surgical risk and maximize late survival after coronary artery bypass grafting in patients with diabetes mellitus. J Thorac Cardiovasc Surg. 2014; 148(4):1257-1264. DOI: 10.1016/j.jtcvs.2014.06.058. View

12.

Chaney M, Nikolov M, Blakeman B, Bakhos M . Attempting to maintain normoglycemia during cardiopulmonary bypass with insulin may initiate postoperative hypoglycemia. Anesth Analg. 1999; 89(5):1091-5. DOI: 10.1213/00000539-199911000-00004. View

13.

Schmeltz L, DeSantis A, Schmidt K, OShea-Mahler E, Rhee C, Brandt S . Conversion of intravenous insulin infusions to subcutaneously administered insulin glargine in patients with hyperglycemia. Endocr Pract. 2007; 12(6):641-50. DOI: 10.4158/EP.12.6.641. View

14.

. 8. Pharmacologic Approaches to Glycemic Treatment: . Diabetes Care. 2017; 41(Suppl 1):S73-S85. DOI: 10.2337/dc18-S008. View

15.

Viana M, Moraes R, Fabbrin A, Santos M, Gerchman F . [Assessment and treatment of hyperglycemia in critically ill patients]. Rev Bras Ter Intensiva. 2014; 26(1):71-6. PMC: 4031893. DOI: 10.5935/0103-507x.20140011. View

16.

Fish L, Weaver T, Moore A, Steel L . Value of postoperative blood glucose in predicting complications and length of stay after coronary artery bypass grafting. Am J Cardiol. 2003; 92(1):74-6. DOI: 10.1016/s0002-9149(03)00472-7. View

17.

Anderson R, Brismar K, Barr G, Ivert T . Effects of cardiopulmonary bypass on glucose homeostasis after coronary artery bypass surgery. Eur J Cardiothorac Surg. 2005; 28(3):425-30. DOI: 10.1016/j.ejcts.2005.05.025. View

18.

Kansagara D, Fu R, Freeman M, Wolf F, Helfand M . Intensive insulin therapy in hospitalized patients: a systematic review. Ann Intern Med. 2011; 154(4):268-82. DOI: 10.7326/0003-4819-154-4-201102150-00008. View

19.

Shroyer A, Hattler B, Wagner T, Baltz J, Collins J, Carr B . Comparing off-pump and on-pump clinical outcomes and costs for diabetic cardiac surgery patients. Ann Thorac Surg. 2014; 98(1):38-44. DOI: 10.1016/j.athoracsur.2014.03.042. View

20.

Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M . Intensive insulin therapy in critically ill patients. N Engl J Med. 2002; 345(19):1359-67. DOI: 10.1056/NEJMoa011300. View