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Câmara de Souza AB, Toyoshima MTK, Cukier P, Lottenberg SA, Bolta PMP, Lima EG, Serrano Júnior CV, Nery M. Electronic Glycemic Management System Improved Glycemic Control and Reduced Complications in Patients With Diabetes Undergoing Coronary Artery Bypass Surgery: A Randomized Controlled Trial. J Diabetes Sci Technol 2024:19322968241268352. [PMID: 39096188 DOI: 10.1177/19322968241268352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2024]
Abstract
BACKGROUND In-hospital hyperglycemia poses significant risks for patients with diabetes mellitus undergoing coronary artery bypass graft (CABG) surgery. Electronic glycemic management systems (eGMSs) like InsulinAPP offer promise in standardizing and improving glycemic control (GC) in these settings. This study evaluated the efficacy of the InsulinAPP protocol in optimizing GC and reducing adverse outcomes post-CABG. METHODS This prospective, randomized, open-label study was conducted with 100 adult type 2 diabetes mellitus (T2DM) patients post-CABG surgery, who were randomized into two groups: conventional care (gCONV) and eGMS protocol (gAPP). The gAPP used InsulinAPP for insulin therapy management, whereas the gCONV received standard clinical care. The primary outcome was a composite of hospital-acquired infections, renal function deterioration, and symptomatic atrial arrhythmia. Secondary outcomes included GC, hypoglycemia incidence, hospital stay length, and costs. RESULTS The gAPP achieved lower mean glucose levels (167.2 ± 42.5 mg/dL vs 188.7 ± 54.4 mg/dL; P = .040) and fewer patients-day with BG above 180 mg/dL (51.3% vs 74.8%, P = .011). The gAPP received an insulin regimen that included more prandial bolus and correction insulin (either bolus-correction or basal-bolus regimens) than the gCONV (90.3% vs 16.7%). The primary composite outcome occurred in 16% of gAPP patients compared with 58% in gCONV (P < .010). Hypoglycemia incidence was lower in the gAPP (4% vs 16%, P = .046). The gAPP protocol also resulted in shorter hospital stays and reduced costs. CONCLUSIONS The InsulinAPP protocol effectively optimizes GC and reduces adverse outcomes in T2DM patients' post-CABG surgery, offering a cost-effective solution for inpatient diabetes management.
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Affiliation(s)
- Alexandre Barbosa Câmara de Souza
- Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcos Tadashi Kakitani Toyoshima
- Oncoendocrinology Service, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Priscilla Cukier
- Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Simão Augusto Lottenberg
- Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Paula Mathias Paulino Bolta
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Eduardo Gomes Lima
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Vicente Serrano Júnior
- Instituto do Coração, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Marcia Nery
- Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
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Hanbeyoglu O, Aydin S. Subfatin, Asprosin, Alamandine and Maresin-1 Inflammation Molecules in Cardiopulmonary Bypass. J Inflamm Res 2023; 16:3469-3477. [PMID: 37605784 PMCID: PMC10440107 DOI: 10.2147/jir.s422998] [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: 05/25/2023] [Accepted: 08/11/2023] [Indexed: 08/23/2023] Open
Abstract
Purpose Cardiopulmonary bypass (CPB) is a nonphysiological procedure in which inflammatory reactions and oxidative stress are induced, hormones and hemodynamic parameters are affected, and circulation is maintained outside the body. This study aimed to examine the effects of CPB on blood subfatin (SUB), asprossin (ASP), alamandine (ALA) and maresin-1 (MaR-1) levels. Materials and Methods Controls and patients who underwent open-heart surgery with CPB and whose age and body mass indices were compatible with each other were included in the study. Venous blood samples were collected from CPB patients (n =19) before anesthesia induction (T1), before CPB (T2), 5 min before cross-clamp removal (T3), 5 min after cross-clamp removal (T4), when taken to the intensive care unit (T5), postoperative 24th hour (T6) and 72nd hour (T7) postoperatively. Venous blood was collected from the healthy controls (n =19). The amounts of SUB, ASP, ALA, and MaR-1 in the blood samples were measured using an Enzyme-Linked Immunosorbent Assay (ELISA). Results The amounts of SUB and MaR-1 in the control group were significantly higher than those in CPB patients, while these parameters in T1-T3 blood gradually decreased in CPB patients (p<0.01). It was also reported that the amounts of ASP and ALA in the control group were significantly lower than those in CPB patients, whereas those parameters in the T1-T3 blood samples increased gradually in CPB patients, but started to decrease in T4-T7 blood samples. Conclusion These hormonal changes in the organism due to CPB demonstrate that "hormonal metabolic adaptation" mechanisms may be activated to eliminate the negative consequences of surgery. According to these data, SUB, MaR-1, anti-alamandine, and anti-asprosin could be used in CPB surgeries may come to the fore in the future to increase the safety of CPB surgeries.
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Affiliation(s)
- Onur Hanbeyoglu
- Department of Anesthesiology, Fethi Sekin City Hospital, Elazig, Turkiye
| | - Suna Aydin
- Department of Cardiovascular Surgery, Fethi Sekin City Hospital, Elazig, Turkiye
- Department of Anatomy, School of Medicine, Firat University, Elazig, Turkiye
- Department of Histology and Embryology, School of Veterinary Medicine, Firat University, Elazig, Turkiye
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Santana Miranda A, Rocha GBF, de Almeida Neto OP, Santos LDR, Ferreira MBG, Magnabosco P, Braga IA, Figueiredo VN. Associations between surgical wound infectious and clinical profile in patients undergoing cardiac surgery. AMERICAN JOURNAL OF CARDIOVASCULAR DISEASE 2021; 11:231-238. [PMID: 34084658 PMCID: PMC8166584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 04/12/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Infections are surgical severe adverse events that pose risks to patient safety in health services, in addition to increasing costs and morbidity and mortality. AIM This study aims to describe the infectious profile of patients undergoing cardiac surgery and associate comorbidities and lifestyle habits with surgical wound infection. DESIGN Observational and retrospective study. METHODS The study included 453 patients undergoing cardiac surgery in a public teaching hospital from January 2014 to January 2019. Data were collected from the clinical records through an instrument composed of variables clinical characteristics, comorbidities, life habits, infection rates, infectious agents, clinical management and surgical wound features. Simple frequency, measures of central tendency and variability, Chi-Square test and logistic regression were used for data analysis. RESULTS There was a predominance of hypertensive patients (367; 81%), smokers (107; 23.6%), alcoholics (76; 16.8%). Surgical wound infection affected 86 (19%) patients. Besides, most patients were under antibiotic therapy (310; 68.4%). Klebsiella pneumoniae; Staphylococcus epidermides and Staphylococcus aureus were the most frequent pathogens. Diabetes Mellitus, nephropathy and age were statistically significant (P<0.05) for higher risk of surgical wound infection. CONCLUSION Chronic diseases and lifestyle habits were related to postoperative infection. More research is needed, focusing on risk factors for the development of surgical wound infection.
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Moorthy V, Liu W, Chew STH, Ti LK. Impact of diabetes on outcomes of cardiac surgery in a multiethnic Southeast Asian population. Diab Vasc Dis Res 2019; 16:549-555. [PMID: 31373219 DOI: 10.1177/1479164119866380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although diabetes is rapidly increasing in Asia and has been shown to be associated with worse cardiac surgery outcomes, no research has been done to study the impact of diabetes on cardiac surgery outcomes in a Southeast Asian cohort. Hence, this study aims to delineate the predictors and impact of diabetes after cardiac surgery in a multi-ethnic Southeast Asian cohort. We analysed data from 2831 adult patients undergoing elective cardiac surgery, from 2008 to 2010 in Singapore. Diabetes was found to significantly increase the odds of intensive care unit readmission by 1.70 (95% confidence interval 1.171-2.480, p = 0.005), postoperative infection by 1.73 (95% confidence interval 1.003-2.976, p = 0.049), acute kidney injury by 1.36 (95% confidence interval 1.137-1.626, p = 0.001), postoperative hyperglycaemia by 6.00 (95% confidence interval 4.893-7.348, p < 0.001), and new need for dialysis by 1.71 (95% 1.086-5.360, p = 0.021). In conclusion, diabetes is associated with increased risk for renal dysfunction, hyperglycaemia, and infection after cardiac surgery, similar to the relative risks of diabetes patients observed in Western populations.
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Affiliation(s)
- Vikaesh Moorthy
- Yong Loo Lin School of Medicine, National University Singapore, Singapore
| | - Weiling Liu
- Department of Anaesthesia, National University Hospital, Singapore
| | | | - Lian Kah Ti
- Department of Anaesthesia, National University Hospital, Singapore
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Fayfman M, Davis G, Duggan EW, Urrutia M, Chachkhiani D, Schindler J, Pasquel FJ, Galindo RJ, Vellanki P, Reyes-Umpierrez D, Wang H, Umpierrez GE. Sitagliptin for prevention of stress hyperglycemia in patients without diabetes undergoing general surgery: A pilot randomized study. J Diabetes Complications 2018; 32:1091-1096. [PMID: 30253968 PMCID: PMC6668912 DOI: 10.1016/j.jdiacomp.2018.08.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 08/23/2018] [Accepted: 08/24/2018] [Indexed: 01/04/2023]
Abstract
AIM We investigated if a dipeptidyl peptidase-4 inhibitor, sitagliptin, can prevent perioperative stress hyperglycemia in patients without prior history of diabetes mellitus undergoing general surgery. METHODS This double-blind pilot trial randomized general surgery patients to receive sitagliptin (n = 44) or placebo (n = 36) once daily, starting one day prior to surgery and continued during the hospital stay. The primary outcome was occurrence of stress hyperglycemia, defined by blood glucose (BG) >140 mg/dL and >180 mg/dL after surgery. Secondary outcomes included: length-of-stay, ICU transfers, hypoglycemia, and hospital complications. RESULTS BG >140 mg/dL was present in 44 (55%) of subjects following surgery. There were no differences in hyperglycemia between placebo and sitagliptin (56% vs. 55%, p = 0.93). BG >180 mg/dL was observed in 19% and 11% of patients treated with placebo and sitagliptin, respectively, p = 0.36. Both treatment groups had resulted in similar postoperative BG (148.9 ± 29.4 mg/dL vs. 146.9 ± 35.2 mg/dL, p = 0.73). There were no differences in length-of-stay (4 vs. 3 days, p = 0.84), ICU transfer (3% vs. 5%, p = 1.00), hypoglycemia <70 mg/dL (6% vs. 11%, p = 0.45), and complications (14% vs. 18%, p = 0.76). CONCLUSION Preoperative treatment with sitagliptin did not prevent stress hyperglycemia or complications in individuals without diabetes undergoing surgery.
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Affiliation(s)
- Maya Fayfman
- Emory University, Department of Medicine, Atlanta, GA, United States of America.
| | - Georgia Davis
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | - Elizabeth W Duggan
- Emory University, Department of Anesthesiology, United States of America
| | - Maria Urrutia
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | - David Chachkhiani
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | - Joanna Schindler
- Emory University, Department of Anesthesiology, United States of America
| | - Francisco J Pasquel
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | - Rodolfo J Galindo
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | - Priyathama Vellanki
- Emory University, Department of Medicine, Atlanta, GA, United States of America
| | | | - Heqiong Wang
- Emory Rollins School of Public Health, United States of America
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Stoudt K, Chawla S. Don't Sugar Coat It: Glycemic Control in the Intensive Care Unit. J Intensive Care Med 2018; 34:889-896. [PMID: 30309291 DOI: 10.1177/0885066618801748] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Stress hyperglycemia is the transient increase in blood glucose as a result of complex hormonal changes that occur during critical illness. It has been described in the critically ill for nearly 200 years; patient harm, including increases in morbidity, mortality, and lengths of stay, has been associated with hyperglycemia, hypoglycemia, and glucose variability. However, there remains a contentious debate regarding the optimal glucose ranges for this population, most notably within the past 15 years. Recent landmark clinical trials have dramatically changed the treatment of stress hyperglycemia in the intensive care unit (ICU). Earlier studies suggested that tight glucose control improved both morbidity and mortality for ICU patients, but later studies have suggested potential harm related to the development of hypoglycemia. Multiple trials have tried to elucidate potential glucose target ranges for special patient populations, including those with diabetes, trauma, sepsis, cardiac surgery, and brain injuries, but there remains conflicting evidence for most of these subpopulations. Currently, most international organizations recommend targeting moderate blood glucose concentration to levels <180 mg/dL for all patients in the intensive care unit. In this review, the history of stress hyperglycemia and its treatment will be discussed including optimal glucose target ranges, devices for monitoring blood glucose, and current professional organizations' recommendations regarding glucose control in the ICU.
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Affiliation(s)
- Kara Stoudt
- Department of Anesthesiology & Critical Care Medicine, Critical Care Medicine Service, Memorial Sloan Kettering Cancer Center, NY, USA
| | - Sanjay Chawla
- Department of Anesthesiology & Critical Care Medicine, Critical Care Medicine Service, Memorial Sloan Kettering Cancer Center, NY, USA
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Abstract
PURPOSE OF REVIEW We discuss key studies that have set the scene for the debate on the efficacy and safety of tight glycemic control in critically ill patients, highlighting important differences among them, and describe the ensuing search towards strategies for safer glucose control. RECENT FINDINGS Differences in level of glycemic control, glucose measurement and insulin administration, expertise, and nutritional management may explain the divergent outcomes of the landmark studies on tight glycemic control in critical illness. Regarding strategies towards safer glucose control, several computerized algorithms have shown promise, but lack validation in adequately powered outcome studies. Real-time continuous glucose monitoring and closed loop blood glucose control systems are not up to the task yet due to technical challenges, though recent advances are promising. Alternatives for insulin have only been investigated in small feasibility studies. Severe hyperglycemia in critically ill patients generally is not tolerated anymore, but the optimal blood glucose target may depend on the specific patient and logistic context.
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Affiliation(s)
- Ilse Vanhorebeek
- Clinical Division and Laboratory of Intensive Care Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Jan Gunst
- Clinical Division and Laboratory of Intensive Care Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Greet Van den Berghe
- Clinical Division and Laboratory of Intensive Care Medicine, KU Leuven, Herestraat 49, 3000, Leuven, Belgium
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Promoting Limb Salvage through Multi-Disciplinary Care of the Diabetic Patient. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2017; 19:55. [PMID: 28567565 DOI: 10.1007/s11936-017-0547-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OPINION STATEMENT Despite an explosion in the number of options available for helping diabetic patients heal wounds, major amputation remains a critical issue for these persons. Since diabetes prematurely ages tissues and no organ system is immune to its presence, it makes inherent sense that multi-disciplinary team approaches to these patients is necessary to make significant strides forward. Here, we present literature from the fields of podiatric surgery/medicine, vascular and plastic surgery and introduce the successes that a multi-disciplinary limb salvage center can have on the lives and limbs of patients with diabetes.
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Xia J, Xu J, Li B, Liu Z, Hao H, Yin C, Xu D. Association between glycemic variability and major adverse cardiovascular and cerebrovascular events (MACCE) in patients with acute coronary syndrome during 30-day follow-up. Clin Chim Acta 2017; 466:162-166. [DOI: 10.1016/j.cca.2017.01.022] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/17/2022]
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