Macrovascular Disease in Diabetes–Clinical Studies
Defining the Target Glycemia in T2DM Patients Undergoing Cardiovascular Surgery
6/24/2013 4:30:00 PM
6/24/2013 4:45:00 PM
, DEBRA FELTS, EDWARD S. KINCAID, DWIGHT DEAL, DAVID GROSSHANS,
The Neurological Outcomes in Diabetics Undergoing Cardiovascular Surgery (CVS) is an NIH sponsored randomized trial of glycemia management for patients with T2DM undergoing CVS. We report glycemia results and complications. Thus far, 121 patients have been enrolled and completed the trial; 58 randomized to INT arm and 63 to CON arm (stratified by age and HbA1c). Glycemia management of INT was started 10 hours before CVS with IV insulin (ins) and continued through surgery and ICU (target 100-140). IV ins was transitioned to sq ins before leaving ICU and continued in the ward with a basal-bolus approach adjusted daily (Fasting target <120 and rest of day <150. CON patients received IV ins during surgery at discretion of anesthesiologist and IV ins in the ICU (target 100-140). CON was treated in the ward by attending physicians (target <200 during years 1-2 of the trial and <180 thereafter).
Pre-CVS glucose was lower for INT (155+/-31) than CON (175+/-53, p <0.01) and also during CVS (INT=152 +/-27, CON= 176 +/-28, p <0.01) but was similar in ICU (INT=138+/-16, CON=140+/-19, p NS). INT had lower glycemia post-surgery (INT=147+/-35, CON = 190 +/- 45, p <0.01).
28 INT and 18 CON patients had at least 1 reading <70. Nine INT and 8 CON patients had at least 1 reading <40. Length of stay in days was similar (INT=7.9 CON=7.4) and also re-admissions (INT=13 CON=15).
Infections in CON (5) was similar to INT (5). One death within 30 days post/op occurred in CON. 3 strokes occurred in INT and 1 in CON.
Summary and conclusions
A treatment strategy which target s fasting glycemia <120 and rest of the day <150 mg/dl in hospitalized T2DM patients undergoing CVS did not decrease LOS or complications. Moreover, it was associated with higher rates of hypoglycemia, both mild and severe and more strokes than a strategy targeting glycemia to <180-200. Our data support refining the current guideline of targeting glycemia to <180 by setting a lower limit of >150 due to safety reasons and lack of improved outcomes.
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