Performance of a 2-step insulin infusion protocol with adjustment of insulin doses for Asians in the medical intensive care unit following cardiothoracic surgery.
Cardiac surgery
Hypoglycemia
Insulin
Insulin infusion protocol
Intensive care unit
Surgical diabetes
Journal
Diabetology international
ISSN: 2190-1678
Titre abrégé: Diabetol Int
Pays: Japan
ID NLM: 101553224
Informations de publication
Date de publication:
Jan 2019
Jan 2019
Historique:
received:
05
04
2018
accepted:
07
06
2018
entrez:
26
2
2019
pubmed:
26
2
2019
medline:
26
2
2019
Statut:
epublish
Résumé
Most previous insulin infusion protocols are titrated for Westerners and are not simple to follow. In this study, we tested the efficacy and safety of our simple insulin infusion protocol utilizing lower insulin doses for Asians. A total of 152 patients with type 2 diabetes undergoing cardiothoracic surgery were included. After surgery, blood glucose (BG) was initially managed according to our algorithm protocol, and subsequently by the post-algorithm protocol. Insulin infusion rates in the algorithm protocol were titrated in two steps according to (1) current BG levels and (2) the difference between current and previous BG levels. In the post-algorithm protocol, insulin lispro was injected subcutaneously in addition to intravenous insulin infusion according to BG levels. The efficacy was assessed as achievement rates of two target BG ranges (140-199 and 80-199 mg/dL), and safety was assessed as hypoglycemia (< 70 mg/dL) and protocol error rates. With the use of the algorithm protocol, 58.7% of 1749 BG measurements achieved a range of 140-199 mg/dL, and 95.9% achieved levels within the 80-199 mg/dL range. Hypoglycemia and protocol error rates were 0.47 and 0.51%, respectively. With the post-algorithm protocol, 48.7 and 98.3% of 898 BG measurements achieved each target range. Hypoglycemia and protocol error rates were 0.78 and 0.22%, respectively. Severe hypoglycemia (< 40 mg/dL) was not observed. Our insulin infusion protocol seems to be efficacious, safe, and widely feasible for Asian patients because of its simplicity and lower insulin dose.
Sections du résumé
BACKGROUND
BACKGROUND
Most previous insulin infusion protocols are titrated for Westerners and are not simple to follow. In this study, we tested the efficacy and safety of our simple insulin infusion protocol utilizing lower insulin doses for Asians.
METHODS
METHODS
A total of 152 patients with type 2 diabetes undergoing cardiothoracic surgery were included. After surgery, blood glucose (BG) was initially managed according to our algorithm protocol, and subsequently by the post-algorithm protocol. Insulin infusion rates in the algorithm protocol were titrated in two steps according to (1) current BG levels and (2) the difference between current and previous BG levels. In the post-algorithm protocol, insulin lispro was injected subcutaneously in addition to intravenous insulin infusion according to BG levels. The efficacy was assessed as achievement rates of two target BG ranges (140-199 and 80-199 mg/dL), and safety was assessed as hypoglycemia (< 70 mg/dL) and protocol error rates.
RESULTS
RESULTS
With the use of the algorithm protocol, 58.7% of 1749 BG measurements achieved a range of 140-199 mg/dL, and 95.9% achieved levels within the 80-199 mg/dL range. Hypoglycemia and protocol error rates were 0.47 and 0.51%, respectively. With the post-algorithm protocol, 48.7 and 98.3% of 898 BG measurements achieved each target range. Hypoglycemia and protocol error rates were 0.78 and 0.22%, respectively. Severe hypoglycemia (< 40 mg/dL) was not observed.
CONCLUSIONS
CONCLUSIONS
Our insulin infusion protocol seems to be efficacious, safe, and widely feasible for Asian patients because of its simplicity and lower insulin dose.
Identifiants
pubmed: 30800560
doi: 10.1007/s13340-018-0358-y
pii: 358
pmc: PMC6357233
doi:
Types de publication
Journal Article
Langues
eng
Pagination
12-23Déclaration de conflit d'intérêts
All the authors declare that they have no conflict of interest.Yoshihiko Nishio has received honoraria for scientific lectures from Eli Lilly. Kazuma Ogiso, Nobuyuki Koriyama, Takahiko Obo, Akinori Tokito, and Takayuki Ueno have nothing to disclose.All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (National Hospital Organization Kagoshima Medical Center, Ethics Committee, date of approval: 6 February 2017, approval no. 28-71) and with the Helsinki Declaration of 1964 and later versions.
Références
N Engl J Med. 2001 Nov 8;345(19):1359-67
pubmed: 11794168
Diabetes Care. 2004 Feb;27(2):354-61
pubmed: 14747213
Diabetes Care. 2004 Feb;27(2):461-7
pubmed: 14747229
Intensive Care Med. 2004 May;30(5):804-10
pubmed: 15127193
Ann Pharmacother. 2004 Jul-Aug;38(7-8):1123-9
pubmed: 15150382
Endocr Pract. 2004 Mar-Apr;10 Suppl 2:21-33
pubmed: 15251637
Mayo Clin Proc. 2004 Aug;79(8):992-1000
pubmed: 15301325
J Cardiothorac Vasc Anesth. 2004 Dec;18(6):690-7
pubmed: 15650975
Pharmacotherapy. 2005 Mar;25(3):352-9
pubmed: 15843282
J Thorac Cardiovasc Surg. 2005 Oct;130(4):1144
pubmed: 16214532
Anesthesiology. 2006 Aug;105(2):244-52
pubmed: 16871057
J Diabetes Complications. 2008 Nov-Dec;22(6):365-70
pubmed: 18413193
Diabetes Res Clin Pract. 2008 Sep;81(3):296-302
pubmed: 18556085
Circulation. 2008 Jul 8;118(2):113-23
pubmed: 18591441
Anesth Analg. 2008 Jul;107(1):51-8
pubmed: 18635467
Ann Thorac Surg. 2009 Feb;87(2):663-9
pubmed: 19161815
N Engl J Med. 2009 Mar 26;360(13):1283-97
pubmed: 19318384
Diabetes Metab. 2010 Feb;36(1):71-8
pubmed: 20097589
Ann Thorac Surg. 2010 Dec;90(6):1818-23
pubmed: 21095317
Ann Thorac Surg. 2010 Dec;90(6):1825-32
pubmed: 21095319
PLoS One. 2012;7(9):e45616
pubmed: 23029136
Diabetes Technol Ther. 2012 Nov;14(11):1013-7
pubmed: 23046399
Diabetes Care. 2013 Jun;36(6):1789-96
pubmed: 23704681
Ann Surg. 2015 Jan;261(1):97-103
pubmed: 25133932
Diabetes Technol Ther. 2016 Aug;18(8):480-6
pubmed: 27257910
J Am Coll Surg. 2017 Jan;224(1):59-74
pubmed: 27915053
JAMA Surg. 2017 Aug 1;152(8):784-791
pubmed: 28467526
Ann Thorac Cardiovasc Surg. 2017 Oct 20;23(5):239-247
pubmed: 28717057
Diabetes Care. 2018 Jan;41(Suppl 1):S144-S151
pubmed: 29222385
Diabetes Care. 1987 Nov-Dec;10(6):722-8
pubmed: 3322729
Ann Thorac Surg. 1997 Feb;63(2):356-61
pubmed: 9033300