| Effects of moderate intensity glycemic control after cardiac surgery. | |
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MedLine Citation:
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PMID: 21095319 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: The impact of intensive insulin therapy on the clinical outcomes of hospitalized patients is highly controversial. We used a protocol based on dynamic insulin administration targeted to achieve moderately tight glycemic control and tested its impact on clinical outcomes after cardiac surgery. METHODS: Patients with diabetes mellitus or random blood glucose greater than 150 mg/dL were treated in the intensive care unit with intravenous insulin, followed by a multi-injection protocol consisting of 4 glargine/aspart insulin injections in the ward, with a glycemic target of 110 to 150 mg/dL. The study cohort (n = 410) consisted of consecutive patients undergoing cardiothoracic surgery. Control patients (n = 207) were admitted during the first 8 months and treated according to standard of care. The intervention group of patients (n = 203) were operated on during the following 8 months. The main outcome measures were glycemic control and the rate of postsurgery infections. RESULTS: During the intervention, mean blood glucose ± SD was 151 ± 19 mg/dL and 157 ± 32 mg/dL in the intensive care unit and ward, respectively, versus 166 ± 27 mg/dL and 184 ± 46 mg/dL during the control period (p < 0.0001). The incidence of hypoglycemia (blood glucose less than 60 mg/dL) was low and similar in the two groups (2.5% control versus 3% intervention). Intensive insulin treatment decreased the risk for infection from 11% to 5% (56% risk reduction, p = 0.018), mainly by reducing the incidence of graft harvest site infection (6.9% versus 2.5%, p = 0.034). The incidence of atrial fibrillation after coronary artery bypass graft surgery decreased from 30% to 18% (39% risk reduction; p = 0.042). CONCLUSIONS: Moderate-intensity dynamic blood glucose control after cardiac surgery is effective and safe, and is associated with improved clinical outcomes. |
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Authors:
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Gil Leibowitz; Ela Raizman; Mayer Brezis; Benjamin Glaser; Itamar Raz; Oz Shapira |
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Publication Detail:
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Type: Comparative Study; Journal Article |
Journal Detail:
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Title: The Annals of thoracic surgery Volume: 90 ISSN: 1552-6259 ISO Abbreviation: Ann. Thorac. Surg. Publication Date: 2010 Dec |
Date Detail:
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Created Date: 2010-11-24 Completed Date: 2011-01-18 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 15030100R Medline TA: Ann Thorac Surg Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1825-32 Citation Subset: AIM; IM |
Copyright Information:
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Copyright © 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Medicine, Endocrinology and Metabolism Service and Hadassah Diabetes Center, Jerusalem, Israel. gleib@hadassah.org.il |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Blood Glucose
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metabolism* Cardiac Surgical Procedures* Diabetes Mellitus / blood, drug therapy* Dose-Response Relationship, Drug Female Follow-Up Studies Heart Diseases / complications, surgery Humans Hypoglycemia / blood, prevention & control* Hypoglycemic Agents / administration & dosage Infusions, Intravenous Insulin / administration & dosage* Intensive Care Units Male Middle Aged Monitoring, Physiologic / methods* Postoperative Care / methods* Prospective Studies Treatment Outcome |
| Chemical | |
Reg. No./Substance:
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0/Blood Glucose; 0/Hypoglycemic Agents; 11061-68-0/Insulin |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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