title: The influence of pre-admission hypoglycaemic therapy on cardiac morbidity and mortality in type 2 diabetic patients undergoing major non-cardiac surgery: a prospective observational study.
abstract: It remains unclear whether type 2 diabetics treated with either insulin or oral hypoglycaemic agents have the same incidence of cardiac morbidity and mortality after major non-cardiac surgery. We prospectively studied 360 type 2 diabetic patients undergoing major non-cardiac surgery of which 105 were treated with insulin only, 171 were treated with oral hypoglycaemics only and 84 were treated with a combination of insulin and oral hypoglycaemics. All-cause mortality after 30 days and after 12 months was highest in the insulin (10% and 26%) and lowest in the oral hypoglycaemics group (2% and 13%; p = 0.02 and 0.007, respectively). Insulin treatment was independently associated with increased mortality after 30 days (hazard ratio 3.93; 95% CI 1.22-12.64; p = 0.022) and 12 months (hazard ratio 2.03; 95% CI 1.16-3.58; p = 0.014) after multivariate adjustment for age, sex and the revised cardiac risk index (insulin treatment excluded). The increased mortality in insulin-treated diabetic patients may be due to a more progressive disease state in these patients rather than the treatment modality itself.
authors: Department of Anaesthesia and Intensive Care Medicine, University Hospital Basel, Basel, Switzerland. dabolliger@uhbs.ch
authors: D
authors: D
authors: Bolliger
authors: M D
authors: MD
authors: Seeberger
authors: G
authors: G
authors: Lurati Buse
authors: P
authors: P
authors: Christen
authors: E
authors: E
authors: Seeberger
authors: W
authors: W
authors: Ruppen
authors: M
authors: M
authors: Filipovic
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001786:Blood Glucose / Q000378:metabolism; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality; D023381:Endpoint Determination; D005260:Female; D006331:Heart Diseases / Q000453:epidemiology* / Q000401:mortality / Q000517:prevention & control; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications; D011184:Postoperative Period; D011446:Prospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000401:mortality*; D014656:Vascular Surgical Procedures
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin