Comparison of insulin infusion protocols targeting 110-140mg/dL in patients after cardiac surgery

Vasudev Magaji, Shriddha Nayak, Amy C. Donihi, Lauren Willard, Srinivasa Jampana, Parachur Nivedita, Raymond Eder, Jann Johnston, Mary T. Korytkowski

Research output: Contribution to journalArticle

Abstract

Background: Continuous intravenous insulin infusion (CII) following coronary artery bypass graft (CABG) surgery reduces postoperative complications and hospitalization duration. Because of limited data evaluating outcomes of CII with revised glycemic targets (110-140mg/dL) in cardiac surgery, this study compared efficacy and safety of two different CII protocols having revised targets. Subjects and Methods: This is a retrospective study comparing two different protocols between August 2009 and March 2010. Protocol 1 consists of four algorithms, and Protocol 2 is a table to adjust CII. Blood glucose (BG) and CII rates were recorded for 48h postoperatively or CII discontinuation. Efficacy was defined by the percentage of BG values in the target range, and safety was defined by the percentage of BG values<40 and 40-69mg/dL. Results: Protocol 1 (n=117) patients were older (65 vs. 61 years; P=0.006) and had more CABG and fewer valve procedures compared with Protocol 2 (n=130). There were no differences in baseline BG level (149±40.6 vs. 151±38.1mg/dL), body mass index (30±6.3 vs. 30±6.4kg/m2), hematocrit (28% vs. 28%), percentage of diabetes patients (32% vs. 31%), percentage of patients with glomerular filtration rate of <30mL/min (5% vs. 6%), CII duration (42 [9-48] vs. 40 [14-48] h), total insulin units received (99 [15-376] vs. 114 [12-457]), hourly insulin rate (median of average rate [range], 2.59 [0-21) vs. 2.96 [0-25] units/h), percentage of BG values 110-140mg/dL, <40mg/dL, 40-69mg/dL, and >180mg/dL, and BG coefficient of variation (21±6.5 vs. 21±6.1). Shorter time to goal (3.32 [0.22-19.35] vs. 5.03 [0.92-19.80] h; P=0.018) and lower mean BG level (127±12.2 vs. 133±12.1mg/dL; P<0.001) were noted with Protocol 1. Discussion: CII protocols targeting 110-140mg/dL were effective in achieving revised targets with low hypoglycemia. Despite differences in mean BG level and time to target, each hospital continued using its existing protocols and identified areas for improvement.

Original languageEnglish (US)
Pages (from-to)1013-1017
Number of pages5
JournalDiabetes Technology and Therapeutics
Volume14
Issue number11
DOIs
StatePublished - Nov 1 2012
Externally publishedYes

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Intravenous Infusions
Thoracic Surgery
Blood Glucose
Insulin
Safety
Hypoglycemia
Coronary Artery Bypass
Hospitalization
Retrospective Studies
Transplants

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medical Laboratory Technology

Cite this

Magaji, V., Nayak, S., Donihi, A. C., Willard, L., Jampana, S., Nivedita, P., ... Korytkowski, M. T. (2012). Comparison of insulin infusion protocols targeting 110-140mg/dL in patients after cardiac surgery. Diabetes Technology and Therapeutics, 14(11), 1013-1017. https://doi.org/10.1089/dia.2012.0114

Comparison of insulin infusion protocols targeting 110-140mg/dL in patients after cardiac surgery. / Magaji, Vasudev; Nayak, Shriddha; Donihi, Amy C.; Willard, Lauren; Jampana, Srinivasa; Nivedita, Parachur; Eder, Raymond; Johnston, Jann; Korytkowski, Mary T.

In: Diabetes Technology and Therapeutics, Vol. 14, No. 11, 01.11.2012, p. 1013-1017.

Research output: Contribution to journalArticle

Magaji, V, Nayak, S, Donihi, AC, Willard, L, Jampana, S, Nivedita, P, Eder, R, Johnston, J & Korytkowski, MT 2012, 'Comparison of insulin infusion protocols targeting 110-140mg/dL in patients after cardiac surgery', Diabetes Technology and Therapeutics, vol. 14, no. 11, pp. 1013-1017. https://doi.org/10.1089/dia.2012.0114
Magaji, Vasudev ; Nayak, Shriddha ; Donihi, Amy C. ; Willard, Lauren ; Jampana, Srinivasa ; Nivedita, Parachur ; Eder, Raymond ; Johnston, Jann ; Korytkowski, Mary T. / Comparison of insulin infusion protocols targeting 110-140mg/dL in patients after cardiac surgery. In: Diabetes Technology and Therapeutics. 2012 ; Vol. 14, No. 11. pp. 1013-1017.
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abstract = "Background: Continuous intravenous insulin infusion (CII) following coronary artery bypass graft (CABG) surgery reduces postoperative complications and hospitalization duration. Because of limited data evaluating outcomes of CII with revised glycemic targets (110-140mg/dL) in cardiac surgery, this study compared efficacy and safety of two different CII protocols having revised targets. Subjects and Methods: This is a retrospective study comparing two different protocols between August 2009 and March 2010. Protocol 1 consists of four algorithms, and Protocol 2 is a table to adjust CII. Blood glucose (BG) and CII rates were recorded for 48h postoperatively or CII discontinuation. Efficacy was defined by the percentage of BG values in the target range, and safety was defined by the percentage of BG values<40 and 40-69mg/dL. Results: Protocol 1 (n=117) patients were older (65 vs. 61 years; P=0.006) and had more CABG and fewer valve procedures compared with Protocol 2 (n=130). There were no differences in baseline BG level (149±40.6 vs. 151±38.1mg/dL), body mass index (30±6.3 vs. 30±6.4kg/m2), hematocrit (28{\%} vs. 28{\%}), percentage of diabetes patients (32{\%} vs. 31{\%}), percentage of patients with glomerular filtration rate of <30mL/min (5{\%} vs. 6{\%}), CII duration (42 [9-48] vs. 40 [14-48] h), total insulin units received (99 [15-376] vs. 114 [12-457]), hourly insulin rate (median of average rate [range], 2.59 [0-21) vs. 2.96 [0-25] units/h), percentage of BG values 110-140mg/dL, <40mg/dL, 40-69mg/dL, and >180mg/dL, and BG coefficient of variation (21±6.5 vs. 21±6.1). Shorter time to goal (3.32 [0.22-19.35] vs. 5.03 [0.92-19.80] h; P=0.018) and lower mean BG level (127±12.2 vs. 133±12.1mg/dL; P<0.001) were noted with Protocol 1. Discussion: CII protocols targeting 110-140mg/dL were effective in achieving revised targets with low hypoglycemia. Despite differences in mean BG level and time to target, each hospital continued using its existing protocols and identified areas for improvement.",
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N2 - Background: Continuous intravenous insulin infusion (CII) following coronary artery bypass graft (CABG) surgery reduces postoperative complications and hospitalization duration. Because of limited data evaluating outcomes of CII with revised glycemic targets (110-140mg/dL) in cardiac surgery, this study compared efficacy and safety of two different CII protocols having revised targets. Subjects and Methods: This is a retrospective study comparing two different protocols between August 2009 and March 2010. Protocol 1 consists of four algorithms, and Protocol 2 is a table to adjust CII. Blood glucose (BG) and CII rates were recorded for 48h postoperatively or CII discontinuation. Efficacy was defined by the percentage of BG values in the target range, and safety was defined by the percentage of BG values<40 and 40-69mg/dL. Results: Protocol 1 (n=117) patients were older (65 vs. 61 years; P=0.006) and had more CABG and fewer valve procedures compared with Protocol 2 (n=130). There were no differences in baseline BG level (149±40.6 vs. 151±38.1mg/dL), body mass index (30±6.3 vs. 30±6.4kg/m2), hematocrit (28% vs. 28%), percentage of diabetes patients (32% vs. 31%), percentage of patients with glomerular filtration rate of <30mL/min (5% vs. 6%), CII duration (42 [9-48] vs. 40 [14-48] h), total insulin units received (99 [15-376] vs. 114 [12-457]), hourly insulin rate (median of average rate [range], 2.59 [0-21) vs. 2.96 [0-25] units/h), percentage of BG values 110-140mg/dL, <40mg/dL, 40-69mg/dL, and >180mg/dL, and BG coefficient of variation (21±6.5 vs. 21±6.1). Shorter time to goal (3.32 [0.22-19.35] vs. 5.03 [0.92-19.80] h; P=0.018) and lower mean BG level (127±12.2 vs. 133±12.1mg/dL; P<0.001) were noted with Protocol 1. Discussion: CII protocols targeting 110-140mg/dL were effective in achieving revised targets with low hypoglycemia. Despite differences in mean BG level and time to target, each hospital continued using its existing protocols and identified areas for improvement.

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