Conversion from intravenous insulin to subcutaneous insulin after cardiovascular surgery: Transition to target study

Mansur E. Shomali, Daniel L. Herr, Peter C. Hill, Marieta Pehlivanova, John M. Sharretts, Michelle F. Magee

Research output: Contribution to journalArticlepeer-review

Abstract

Background: No study of transition from intravenous to subcutaneous insulin after cardiac surgery with dose based on percentage of intravenous total daily insulin (TDI) has reported a clearly superior regimen for achieving target blood glucose. We compared three first-dose transition strategies for insulin glargine: two based on TDI alone and one that also took body weight into account. Methods: Mostly obese, type 1 and type 2 diabetes patients (n = 223) undergoing cardiac surgery were randomized to receive insulin glargine subcutaneously at 60% or 80% of TDI or in a dose based on TDI and body weight. Results: Transition to subcutaneous insulin occurred 27.4 ± 6.6?h after surgery. Over the study period, mean proportion of blood glucose values within target range (80-140?mg/dL) were 0.34 ± 0.24, 0.35 ± 0.24, and 0.36 ± 0.22 in the 60% TDI, 80% TDI, and weight-based groups, respectively. This difference was not significant. Significantly more insulin corrections were needed in the 60% TDI group than in the weight-based group. There was only one incidence of hypoglycemia (blood glucose <40?mg/dL). Conclusions: No subcutaneous insulin regimen implemented approximately 1 day after cardiac surgery showed significantly better control of blood glucose over the 3-day study period. Further studies are needed to determine optimal formulae for effecting an early transition to subcutaneous insulin after cardiac surgery or whether it is preferable and/or necessary to continue intravenous insulin therapy for an additional period of time.

Original languageEnglish (US)
Pages (from-to)121-126
Number of pages6
JournalDiabetes Technology and Therapeutics
Volume13
Issue number2
DOIs
StatePublished - Feb 1 2011

ASJC Scopus subject areas

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

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