Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery
Since we are getting obsessive about tight control of blood glucose, concerns have been expressed about potential hypoglycemia. Many studies have shown that hypoglycemia during "tight" blood glucose control is a real danger with significant morbidity and mortality.
One recent study from Mayo Clinic, Rochester, MN compared intensive intraoperative insulin therapy with conventional glucose management during cardiac surgery. Patients were randomly assigned to tight glucose control (80-100 mg/dL) with continuous insulin infusion) or conventional treatment (n = 201).
- Patients in the conventional treatment group were given insulin during surgery if glucose levels were greater than 200 mg/dL.
- Both groups were treated with insulin infusion to maintain normoglycemia after surgery.
- Eighty two of 185 patients (44%) in the intensive treatment group and 86 of 186 patients (46%) in the conventional treatment group had an event.
- More deaths (4 deaths vs. 0 deaths) and strokes (8 strokes vs. 1 strokes) occurred in the intensive treatment group.
Study concluded that Intensive insulin therapy during cardiac surgery does not reduce perioperative death or morbidity. The increased incidence of death and stroke in the intensive treatment group raises concern about routine implementation of this intervention.
Reference: click to get abstract/article
Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery, A Randomized Trial, Annals of internal Medicine, 20 February 2007 Volume 146 Issue 4 Pages 233-243