title: A randomized study in diabetic patients undergoing cardiac surgery comparing computer-guided glucose management with a standard sliding scale protocol.
abstract: OBJECTIVE
  The aim of this study was to compare a standard insulin protocol with a computer-guided glucose management system to determine which method achieves tighter glucose control.
  
  
  METHODS
  A prospective, randomized trial.
  
  
  METHODS
  A cardiothoracic intensive care unit (ICU) in a large academic medical center.
  
  
  METHODS
  Forty patients with diabetes mellitus who were scheduled for cardiac surgery.
  
  
  METHODS
  After induction of anesthesia and for the first 9 hours in the ICU, each subject received a standardized infusion of a 10% glucose solution at a rate of 1.0 mL/kg/h (ideal body weight). The subjects were then randomized to have their glucose controlled by either a paper-based insulin protocol or by a computer-guided glucose management system (CG). The desired range for blood glucose was set between 90 and 150 mg/dL.
  
  
  RESULTS
  There were no differences between groups in baseline characteristics. Patients in the CG group spent more time in the desired range during both the intraoperative phase (49% v 27%, p = 0.001) and the ICU phase (84% v 60%, p < 0.0001). There were no statistical differences between groups in the number of hypoglycemia episodes.
  
  
  CONCLUSIONS
  The computer-guided glucose management system achieved tighter blood glucose control than a standard paper-based protocol in diabetic patients undergoing cardiac surgery. However, the low proportion of blood glucose recordings within the desired range in both groups during the intraoperative period reflects the challenges associated with achieving normoglycemia during cardiac surgery.
authors.affiliation: Department of Anesthesiology, Washington University School of Medicine, St Louis, MO 63110, USA.
authors.forename: Leif
authors.initials: L
authors.lastname: Saager
authors.forename: Gordon L
authors.initials: GL
authors.lastname: Collins
authors.forename: Beth
authors.initials: B
authors.lastname: Burnside
authors.forename: Heidi
authors.initials: H
authors.lastname: Tymkew
authors.forename: Lini
authors.initials: L
authors.lastname: Zhang
authors.forename: Eric
authors.initials: E
authors.lastname: Jacobsohn
authors.forename: Michael
authors.initials: M
authors.lastname: Avidan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000032:analysis / Q000378:metabolism*; D013504:Cardiovascular Surgical Procedures / Q000379:methods* / Q000592:standards; D003920:Diabetes Mellitus / Q000097:blood* / Q000188:drug therapy / Q000601:surgery*; D019468:Disease Management; D004360:Drug Therapy, Computer-Assisted / Q000379:methods* / Q000592:standards*; D005260:Female; D005947:Glucose / Q000008:administration & dosage; D006801:Humans; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods / Q000592:standards; D011446:Prospective Studies
chemical_list: D001786:Blood Glucose; D005947:Glucose