Perioperative blood glucose variability and autonomic nervous system activity in on-pump cardiac surgery patients: Study protocol of a single-center observational study.
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
25 Nov 2022
25 Nov 2022
Historique:
entrez:
1
12
2022
pubmed:
2
12
2022
medline:
3
12
2022
Statut:
ppublish
Résumé
On-pump coronary artery bypass graft (CABG) and surgical valve replacement (SVR) are high-risk procedures. Several studies reported that perioperative blood glucose (BG) variability was independently associated with impaired postoperative outcome. However, the underlying mechanisms contributing to increased perioperative BG variability and to its deleterious impact remain unknown. The hypothesis of the study is that perioperative BG variability could be related to perioperative alteration of the autonomic nervous system (ANS) activity and to preoperative BG variability. We designed a prospective observational single-center study. Four groups of 30 patients will be studied: group 1, including insulin-requiring type 2 diabetic patients undergoing on-pump CABG; group 2, including non-insulin-requiring type 2 diabetic patients undergoing on-pump CABG; group 3, including non-diabetic patients undergoing aortic SVR; and group 4, including non-diabetic patient undergoing on-pump CABG. Preoperative (baseline) and postoperative BG variability will be quantified using the Abbott's Freestyle Libre Pro sensor allowing for continuous subcutaneous BG monitoring. Preoperative (baseline) and postoperative ANS activity will be measured using noninvasive continuous heart rate monitoring (Mooky HR memory®). Blood level and urinary concentration of inflammatory and endothelial dysfunction biomarkers will be measured from blood and urinary samples at the end of the surgery and on postoperative day 1 and 2. The primary objective is to describe the relationship between baseline BG variability and postoperative BG variability. The secondary objectives are to describe the relationship: between baseline and postoperative BG variability according to the diabetes phenotype and to the type of surgery; between the ANS activity and the BG variability; and between postoperative BG variability and, urinary and blood biomarkers.
Identifiants
pubmed: 36451410
doi: 10.1097/MD.0000000000031821
pii: 00005792-202211250-00034
pmc: PMC9704965
doi:
Substances chimiques
Blood Glucose
0
Insulin
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e31821Informations de copyright
Copyright © 2022 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no conflict of interest to disclose.
Références
Egi M, Bellomo R, Stachowski E, et al. Variability of blood glucose concentration and short - term mortality in critically ill patients. Anesthesiology. 2006;105:244–52.
Besch G, Pili-Floury, S, Morel C, et al. Impact of post - procedural glycemic variability on cardiovascular morbidity and mortality after transcatheter aortic valve implantation: a post hoc cohort analysis. Cardiovasc Diabetol. 2019;18.
Zhang J, He L, Cao S, et al. Effect of glycemic variability on short term prognosis in acute myocardial infarction subjects undergoing primary percutaneous coronary interventions. Diabetol Metab Syndr. 2014;6:76.
Ogawa S, Okawa Y, Sawada K, et al. Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: a propensity - matched analysis. Eur J Cardiothorac Surg. 2016;49:420–6.
Subramaniam 2014 Increased Glycemic Variability in Patients With El.pdf.
Bansal B, Carvalho P, Mehta Y, et al. Prognostic significance of glycemic variability after cardiac surgery. J Diabetes Complicat. 2016;30:613–7.
Lin R, Brown F, James S, et al. Continuous glucose monitoring: a review of the evidence in type 1 and 2 diabetes mellitus. Diabet Med. 2021;38.
Smith-Palmer J, Brändle M, Trevisan R, et al. Assessment of the association between glycemic variability and diabetes - related complications in type 1 and type 2 diabetes. Diabetes Res Clin Pract. 2014;105:273–84.
Fleischer J, Lebech Cichosz S, Hoeyem P, et al. Glycemic variability is associated with reduced cardiac autonomic modulation in women with type 2 diabetes. Diabetes Care. 2015:dc140654.
Jun JE, Jin SM, Baek J, et al. The association between glycemic variability and diabetic cardiovascular autonomic neuropathy in patients with type 2 diabetes. Cardiovasc Diabetol. 2015;14:70.
Helleputte S, De Backer T, Lapauw B, et al. The relationship between glycaemic variability and cardiovascular autonomic dysfunction in patients with type 1 diabetes: a systematic review. Diabetes Metab Res Rev. 2020;36.
Matsutani D, Sakamoto M, Iuchi H, et al. Glycemic variability in continuous glucose monitoring is inversely associated with baroreflex sensitivity in type 2 diabetes: a preliminary report. Cardiovasc Diabetol. 2018;17:36.
Xu W, Zhu Y, Yang X, et al. Glycemic variability is an important risk factor for cardiovascular autonomic neuropathy in newly diagnosed type 2 diabetic patients. Int J Cardiol. 2016;215:263–8.
Monnier, et al. Activation of Oxidative Stress by Acute Glucose Fl.pdf.
Ceriello, et al. 2019 Glycaemic variability in diabetes clinical and th.pdf.
Buscemi S, Re A, Batsis JA, et al. Glycaemic variability using continuous glucose monitoring and endothelial function in the metabolic syndrome and in Type 2 diabetes: glycaemic variability and endothelial function. Diabet Med. 2010;27:872–8.
Chan AW, Tetzlaff JM, Altman DG, et al. SPIRIT 2013 statement: defining standard protocol items for clinical trials. Ann Intern Med. 2013;158:200.
Studer C, Sankou W, Penfornis A, et al. Efficacy and safety of an insulin infusion protocol during and after cardiac surgery. Diabetes Metab. 2010;36:71–8.
Goldberg PA, Siegel MD, Sherwin RS, et al. Implementation of a safe and effective insulin infusion protocol in a medical intensive care unit. Diabetes Care. 2004;27:461–7.
Sletten DM, Suarez GA, Low PA, et al. COMPASS 31: a refined and abbreviated composite autonomic symptom score. Mayo Clin Proc. 2012;87:1196–201.
D’Amato C, Greco C, Lombardo G, et al. The diagnostic usefulness of the combined COMPASS 31 questionnaire and electrochemical skin conductance for diabetic cardiovascular autonomic neuropathy and diabetic polyneuropathy. J Peripher Nerv Syst JPNS. 2020;25:44–53.
Greco C, Di Gennaro F, D’Amato C, et al. Validation of the composite autonomic symptom score 31 (COMPASS 31) for the assessment of symptoms of autonomic neuropathy in people with diabetes. Diabet Med J Br Diabet Assoc. 2017;34:834–8.
Heart rate variability: standards of measurement, physiological interpretation, and clinical use. Task force of the European society of cardiology and the North American Society of Pacing and Electrophysiology. Eur Heart J. 1996;17:354–81.
Akselrod S, Gordon D, Ubel FA, et al. Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat - to - beat cardiovascular control. Science. 1981;213:220–2.
Benichou T, Pereira B, Mermillod M, et al. Heart rate variability in type 2 diabetes mellitus: a systematic review and meta - analysis. PLoS One. 2018;13:e0195166.
Toulouse E, Lafont B, Granier S, et al. French legal approach to patient consent in clinical research. Anaesth Crit Care Pain Med. 2020;39:883–5.
Toulouse E, Masseguin C, Lafont B, et al. French legal approach to clinical research. Anaesth Crit Care Pain Med. 2018;37:607–14.