title: Conversion from intravenous insulin to subcutaneous insulin after cardiovascular surgery: transition to target study.
abstract: BACKGROUND
  No study of transition from intravenous to subcutaneous insulin after cardiac surgery with dose based on percentage of intravenous total daily insulin (TDI) has reported a clearly superior regimen for achieving target blood glucose. We compared three first-dose transition strategies for insulin glargine: two based on TDI alone and one that also took body weight into account.
  
  
  METHODS
  Mostly obese, type 1 and type 2 diabetes patients (n = 223) undergoing cardiac surgery were randomized to receive insulin glargine subcutaneously at 60% or 80% of TDI or in a dose based on TDI and body weight.
  
  
  RESULTS
  Transition to subcutaneous insulin occurred 27.4 ± 6.6 h after surgery. Over the study period, mean proportion of blood glucose values within target range (80-140 mg/dL) were 0.34 ± 0.24, 0.35 ± 0.24, and 0.36 ± 0.22 in the 60% TDI, 80% TDI, and weight-based groups, respectively. This difference was not significant. Significantly more insulin corrections were needed in the 60% TDI group than in the weight-based group. There was only one incidence of hypoglycemia (blood glucose < 40 mg/dL).
  
  
  CONCLUSIONS
  No subcutaneous insulin regimen implemented approximately 1 day after cardiac surgery showed significantly better control of blood glucose over the 3-day study period. Further studies are needed to determine optimal formulae for effecting an early transition to subcutaneous insulin after cardiac surgery or whether it is preferable and/or necessary to continue intravenous insulin therapy for an additional period of time.
authors.affiliation: Department of Medicine, Union Memorial Hospital, Baltimore, Maryland 21218, USA. mansur.shomali@medstar.net
authors.forename: Mansur E
authors.initials: ME
authors.lastname: Shomali
authors.forename: Daniel L
authors.initials: DL
authors.lastname: Herr
authors.forename: Peter C
authors.initials: PC
authors.lastname: Hill
authors.forename: Marieta
authors.initials: M
authors.lastname: Pehlivanova
authors.forename: John M
authors.initials: JM
authors.lastname: Sharretts
authors.forename: Michelle F
authors.initials: MF
authors.lastname: Magee
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D015992:Body Mass Index; D002318:Cardiovascular Diseases / Q000150:complications / Q000601:surgery*; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D054796:Drug Dosage Calculations; D016903:Drug Monitoring; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007003:Hypoglycemia / Q000139:chemically induced / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000009:adverse effects / Q000627:therapeutic use; D007279:Injections, Subcutaneous; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000150:complications; D011182:Postoperative Care / Q000009:adverse effects / Q000379:methods*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin; D000069036:Insulin Glargine; D049528:Insulin, Long-Acting; C517652:hemoglobin A1c protein, human