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Sheybani S, Kahrom M, Ganjali R, Kalati SM, Zirak N, Ghorani V. Effects of glargine on hyperglycemia in patients with diabetes mellitus type II undergoing off-pump coronary artery bypass graft: A randomized, controlled, double-blind clinical trial. J Cardiovasc Thorac Res 2023; 15:44-50. [PMID: 37342663 PMCID: PMC10278194 DOI: 10.34172/jcvtr.2023.31596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 02/10/2023] [Indexed: 06/23/2023] Open
Abstract
Introduction: In this trial, effects of glargine on hyperglycemia in patients with diabetes mellitus type II who were undergoing off-pump coronary artery bypass graft (CAGB), were examined. Methods: Seventy diabetic patients who were candidate for off-pump CABG were randomly divided into the following two groups (1) Control group who were treated with normal saline+regular insulin and (2) Glargine group who received glargine+regular insulin. Normal saline and glargine were administered subcutaneously 2 hours before surgery, and regular insulin was injected before, during and after the surgery in the intensive care unit (ICU) in both groups. Finally, levels of blood sugar before, 2 hours after starting the surgery and at the end of the surgery, were recorded. Blood sugar levels during ICU stay were also measured every 4 hours for 36 hours. Results: There were no significant differences in blood sugar levels between the groups at the three time points (i.e. before, 2 hours after starting the surgery and at the end of the surgery). In addition, during 36 hours of ICU stay, blood sugar levels did not show significant variations between the groups; however, 20 hours after ICU admission, blood sugar level was significantly higher in the glargine group (P=0.04). Conclusion: The results indicated that both glargine and regular insulin effectively control the blood glucose in diabetic patients undergoing CABG. However, the blood sugar fluctuation was less in the glargine group than control group.
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Affiliation(s)
- Shima Sheybani
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Mahdi Kahrom
- Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Raheleh Ganjali
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Seyedeh Mahsa Kalati
- Department of Anesthesiology, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nahid Zirak
- Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Vahideh Ghorani
- Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Page S, Yong MS, Saxena P, Yadav S. Outcomes in Dialysis-Dependent Indigenous and Non-Indigenous Patients Undergoing Cardiac Surgery at Townsville University Hospital. Heart Lung Circ 2021; 30:1200-1206. [PMID: 33744195 DOI: 10.1016/j.hlc.2021.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 01/09/2021] [Accepted: 02/10/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Dialysis-dependent patients have a high risk of cardiovascular death but also a high risk for perioperative mortality in cardiac surgery. Our study examined surgical complications and mortality in Indigenous and non-Indigenous dialysis-dependent patients undergoing cardiac surgery at a single centre. METHODOLOGY The retrospective study reviewed 72 consecutive dialysis-dependent patients who underwent cardiac surgery between 2008 and 2018. Data was prospectively collected, and follow-up was obtained from physicians and general practitioners. Multivariable analysis was performed to determine predictors of mortality. RESULTS The median age of Indigenous Australian patients was 60 years, compared with 65 years for non-Indigenous patients. Indigenous Australian patients had a significantly higher rate of return to theatre (43% versus 17%). The predominant reason for return to theatre for the whole cohort was postoperative bleeding (n=16, 22%). The overall early mortality rate was 10%. There were 35 late deaths (49%) and overall survival at 5 years was 40.92±6.8% (95% CI: 28-54%). History of arrhythmia (p=0.019) was a significant risk factor for mortality, whilst patients who underwent isolated coronary artery bypass grafting (p=0.004), and those who received internal mammary artery grafts (p=0.021) had a reduced hazard ratio for mortality. The median follow-up time was 29 months (IQR 10-52 mo). CONCLUSION Dialysis-dependent Indigenous Australian patients present younger for cardiac surgery, with a higher prevalence of co-morbid diabetes and more extensive coronary artery disease. There was no statistically significant difference in early or late mortality between Indigenous and non-Indigenous patients. However, there was a higher rate of return to theatre amongst the Indigenous Australian cohort.
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Affiliation(s)
- Sarah Page
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, Qld, Australia.
| | - Matthew S Yong
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, Qld, Australia
| | - Pankaj Saxena
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, Qld, Australia; James Cook University, Townsville, Qld, Australia
| | - Sumit Yadav
- Department of Cardiothoracic Surgery, Townsville University Hospital, Townsville, Qld, Australia; James Cook University, Townsville, Qld, Australia
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Zia A, Hasan M, Ilyas S, Siddiqui HU, Tappuni B, Marsia S, Zubair MM, Raza S, Mustafa RR, Baloch ZQ, Deo SV, Sharma UM, Sheikh MA. Reining in Sternal Wound Infections: The Achilles' Heel of Bilateral Internal Thoracic Artery Grafting. Surg Infect (Larchmt) 2020; 21:323-331. [DOI: 10.1089/sur.2018.142] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Affiliation(s)
- Aisha Zia
- Department of Thoracic & Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Marium Hasan
- Department of Urology, The Kidney Centre, Karachi, Pakistan
| | - Sidra Ilyas
- Department of Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
| | - Hafiz Umair Siddiqui
- Department of Thoracic & Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Bassman Tappuni
- Department of Thoracic & Cardiovascular Surgery, Heart & Vascular Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Shayan Marsia
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - M. Mujeeb Zubair
- Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, Texas, USA
| | - Sajjad Raza
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Rami R. Mustafa
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | | | - Salil V. Deo
- University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Umesh M. Sharma
- Community Division of Hospital Medicine, Mayo Clinic Health System, Rochester, Minnesota, USA
| | - Mohammad Adil Sheikh
- Department of Medicine, Detroit Medical Center/Wayne State University, Detroit, Michigan, USA
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Basha AA, Vivekanandan S, Parthasarathy P. Blood Glucose Regulation for Post-Operative Patients with Diabetics and Hypertension Continuum: A Cascade Control-Based Approach. J Med Syst 2019; 43:95. [PMID: 30847581 DOI: 10.1007/s10916-019-1224-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/21/2019] [Indexed: 11/24/2022]
Abstract
Management of glycemic level in post-operative condition is critical for hypertensive patients and the post-operative stress may results in hyperglycemia, hyper insulin and osmotic diuresis. Recent medical research shows that diabetic and hypertension hands together in a significant overlap in its etiology and its disease mechanism. It is clear that there is a call for monitoring in the parameter and controlling the glucose level particularly in the presence of hypertension. This paper proposes the novel complex (cascade) control system to control the insulin infusion level particularly in the presence of hypertension. Based on the requirements the structure has been designed and the simulation results indicates that the proposed control strategy shows better results and may achieve potentially better glycemic control to the hypersensitive diabetic patients.
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Affiliation(s)
- A Alavudeen Basha
- School of Electrical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, 632 014, India.
| | - S Vivekanandan
- School of Electrical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, 632 014, India
| | - P Parthasarathy
- School of Electrical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu, 632 014, India
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Greco G, Ferket BS, D'Alessandro DA, Shi W, Horvath KA, Rosen A, Welsh S, Bagiella E, Neill AE, Williams DL, Greenberg A, Browndyke JN, Gillinov AM, Mayer ML, Keim-Malpass J, Gupta LS, Hohmann SF, Gelijns AC, O'Gara PT, Moskowitz AJ. Diabetes and the Association of Postoperative Hyperglycemia With Clinical and Economic Outcomes in Cardiac Surgery. Diabetes Care 2016; 39:408-17. [PMID: 26786574 PMCID: PMC4764032 DOI: 10.2337/dc15-1817] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Accepted: 12/15/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVE The management of postoperative hyperglycemia is controversial and generally does not take into account pre-existing diabetes. We analyzed clinical and economic outcomes associated with postoperative hyperglycemia in cardiac surgery patients, stratifying by diabetes status. RESEARCH DESIGN AND METHODS Multicenter cohort study in 4,316 cardiac surgery patients operated on in 2010. Glucose was measured at 6-h intervals for 48 h postoperatively. Outcomes included cost, hospital length of stay (LOS), cardiac and respiratory complications, major infections, and death. Associations between maximum glucose levels and outcomes were assessed with multivariable regression and recycled prediction analyses. RESULTS In patients without diabetes, increasing glucose levels were associated with a gradual worsening of outcomes. In these patients, hyperglycemia (≥180 mg/dL) was associated with an additional cost of $3,192 (95% CI 1,972 to 4,456), an additional hospital LOS of 0.8 days (0.4 to 1.3), an increase in infections of 1.6% (0.5 to 2.8), and an increase in respiratory complications of 2.6% (0.0 to 5.3). However, among patients with insulin-treated diabetes, optimal outcomes were associated with glucose levels considered to be hyperglycemic (180 to 240 mg/dL). This level of hyperglycemia was associated with cost reductions of $6,225 (-12,886 to -222), hospital LOS reductions of 1.6 days (-3.7 to 0.4), infection reductions of 4.1% (-9.1 to 0.0), and reductions in respiratory complication of 12.5% (-22.4 to -3.0). In patients with non-insulin-treated diabetes, outcomes did not differ significantly when hyperglycemia was present. CONCLUSIONS Glucose levels <180 mg/dL are associated with better outcomes in most patients, but worse outcomes in patients with diabetes with a history of prior insulin use. These findings support further investigation of a stratified approach to the management of patients with stress-induced postoperative hyperglycemia based on prior diabetes status.
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Affiliation(s)
- Giampaolo Greco
- International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Bart S Ferket
- International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - David A D'Alessandro
- Department of Cardiothoracic Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, New York, NY
| | - Wei Shi
- International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Keith A Horvath
- Department of Cardiothoracic Surgery, NIH Heart Center at Suburban Hospital, Bethesda, MD
| | | | - Stacey Welsh
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, NC
| | - Emilia Bagiella
- International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexis E Neill
- Department of Cardiothoracic Surgery, Emory University Hospital Midtown, Atlanta, GA
| | - Deborah L Williams
- International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Ann Greenberg
- Department of Cardiothoracic Surgery, NIH Heart Center at Suburban Hospital, Bethesda, MD
| | - Jeffrey N Browndyke
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, Durham, NC
| | - A Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Cleveland, OH
| | - Mary Lou Mayer
- Department of Surgery, Division of Cardiovascular Surgery, University of Pennsylvania School of Medicine, Philadelphia, PA
| | - Jessica Keim-Malpass
- Division of Thoracic and Cardiovascular Surgery, University of Virginia School of Medicine, Charlottesville, VA
| | - Lopa S Gupta
- International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | | | - Annetine C Gelijns
- International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Patrick T O'Gara
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA
| | - Alan J Moskowitz
- International Center for Health Outcomes and Innovation Research (InCHOIR), the Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY
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Guidelines for Perioperative Management of the Diabetic Patient. Surg Res Pract 2015; 2015:284063. [PMID: 26078998 PMCID: PMC4452499 DOI: 10.1155/2015/284063] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 05/05/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Management of glycemic levels in the perioperative setting is critical, especially in diabetic patients. The effects of surgical stress and anesthesia have unique effects on blood glucose levels, which should be taken into consideration to maintain optimum glycemic control. Each stage of surgery presents unique challenges in keeping glucose levels within target range. Additionally, there are special operative conditions that require distinctive glucose management protocols. Interestingly, the literature still does not report a consensus perioperative glucose management strategy for diabetic patients. We hope to outline the most important factors required in formulating a perioperative diabetic regimen, while still allowing for specific adjustments using prudent clinical judgment. Overall, through careful glycemic management in perioperative patients, we may reduce morbidity and mortality and improve surgical outcomes.
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Stahnke A, Struemph K, Behnen E, Schimmelpfennig J. Pharmacy management of postoperative blood glucose in open heart surgery patients: evaluation of an intravenous to subcutaneous insulin protocol. Hosp Pharm 2014; 49:164-9. [PMID: 24623869 DOI: 10.1310/hpj4902-164] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE To develop and implement a protocol to improve blood glucose (BG) control during transition from intravenous (IV) to subcutaneous (SC) insulin, increase compliance with Surgical Care Improvement Project (SCIP) measures, and decrease sternal wound infections post open heart surgery (OHS). METHODS An IV to SC protocol was developed and implemented. A retrospective chart review of patients who underwent OHS was conducted from January 2, 2009 to September 30, 2010 (pre protocol) and from October 1, 2010 to December 31, 2011 (post protocol). Data collected included age, sex, history of diabetes mellitus (DM), BG values, hypoglycemia incidence, length of stay, and incidence of sternal wound infections. RESULTS A total of 243 patients were included in the study. Compliance with SCIP postoperative day 1 and 2 BG goals was similar pre and post protocol (P = .24 and .248). One sternal wound infection occurred after protocol implementation, whereas 6 occurred pre protocol (P = .046). Change in BG when transitioning from IV to SC insulin was similar between the groups, however there were significantly fewer hypoglycemia episodes post protocol (P < .001). CONCLUSION Though differences were not found in compliance with SCIP postoperative day 1 and 2 measures, fewer sternal wound infections and hypoglycemic episodes were reported, indicating that the pharmacy protocol may have a positive impact on patient outcomes.
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Affiliation(s)
- Amanda Stahnke
- Clinical Assistant Professor, University of Missouri-Kansas City School of Pharmacy , Kansas City, Missouri
| | - Kelly Struemph
- Clinical Pharmacy Lead, Menorah Medical Center , Overland Park, Kansas
| | - Erin Behnen
- Associate Professor, Southern Illinois University Edwardsville School of Pharmacy , Edwardsville, Illinois
| | - Julia Schimmelpfennig
- Pharmacy Manager - Clinical Services , PGY-1 Residency Program Director, St. Elizabeth's Hospital, Belleville, Illinois
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Talley MH, Hill A, Steadman L, Hess MA. Changes in the treatment of inpatient hyperglycemia: What every nurse practitioner should know about the 2012 Standards of Care. ACTA ACUST UNITED AC 2012. [DOI: 10.1111/j.1745-7599.2012.00770.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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