title: Preinduction glycemia and body mass index are important predictors of perioperative insulin management in patients undergoing cardiac surgery.
abstract: OBJECTIVE
  To investigate whether preinduction glucose is an important predictor for perioperative insulin management in patients undergoing cardiac surgery.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Large community hospital.
  
  
  METHODS
  80 consecutive patients scheduled for cardiac surgery.
  
  
  METHODS
  Patients were subdivided into those with a preinduction blood glucose of 110 mg/dL or lower with or without history of diabetes (group 1) and those with a preinduction blood glucose of above 110 mg/dL with or without history of diabetes (group 2). In group 1, there were no known diabetics. In group 2, 31% (11/35) had diabetes (group 2DM), while 24/35 (69%) did not (group 2NDM). An insulin infusion was started intraoperatively and adjusted according to a strict protocol in order to maintain normoglycemia (80-110 mg/dL) until discharge from intensive care.
  
  
  RESULTS
  In patients with preinduction glucose above 110 mg/dL, whether or not previously treated for diabetes, perioperative insulin requirements were higher, and intraoperative insulin management was more difficult than in those with lower preinduction glucose. In patients with a preinduction glucose above 110 mg/dL, hospital stay was longer, and inhospital mortality was significantly higher than in those with lower preinduction glucose. Multivariate analyses showed that preinduction glycemia was a good predictor of intraoperative insulin consumption, as was the body mass index (BMI) for intensive care and total insulin needs.
  
  
  CONCLUSIONS
  In cardiac surgical patients with a preinduction glucose above 110 mg/dL, even if diabetes was not previously suspected, perioperative insulin requirements were higher, and intraoperative insulin management is more difficult than in those with a preinduction glucose 110 mg/dL or lower. Preinduction glycemia and BMI are good predictors of perioperative insulin management. Preinduction glycemia above 110 mg/dL predicts difficult perioperative glucose control and, moreover, that a preinduction blood glucose of 110 mg/dL or lower is associated with less insulin need.
authors.affiliation: Department of Anesthesiology and Critical Care Medicine, OLV Clinic, 9300 Aalst, Belgium. guy.cammu@olvz-aalst.be
authors.forename: Guy
authors.initials: G
authors.lastname: Cammu
authors.forename: Patrick
authors.initials: P
authors.lastname: Lecomte
authors.forename: Filip
authors.initials: F
authors.lastname: Casselman
authors.forename: Ignace
authors.initials: I
authors.lastname: Demeyer
authors.forename: José
authors.initials: J
authors.lastname: Coddens
authors.forename: Karl
authors.initials: K
authors.lastname: Morias
authors.forename: Thierry
authors.initials: T
authors.lastname: Deloof
authors.forename: Frank
authors.initials: F
authors.lastname: Nobels
authors.forename: Paul
authors.initials: P
authors.lastname: Van Crombrugge
authors.forename: Luc
authors.initials: L
authors.lastname: Foubert
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D001786:Blood Glucose / Q000032:analysis* / Q000187:drug effects; D015992:Body Mass Index; D006348:Cardiac Surgical Procedures; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage*; D007328:Insulin / Q000008:administration & dosage*; D008297:Male; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin