title: Intensive glycemic control after heart transplantation is safe and effective for diabetic and non-diabetic patients.
abstract: Some studies have shown increased mortality, infection, and rejection rates among diabetic (DM) compared to non-diabetic (non-DM) patients undergoing heart transplant (HT). This is a retrospective chart review of adult patients (DM, n = 26; non-DM, n = 66) undergoing HT between June 1, 2005, and July 31, 2009. Glycemic control used intravenous (IV) and subcutaneous (SQ) insulin protocols with a glucose target of 80-110 mg/dL. There were no significant differences between DM and non-DM patients in mean glucose levels on the IV and SQ insulin protocols. Severe hypoglycemia (glucose <40 mg/dL) did not occur on the IV protocol and was experienced by only 3 non-DM patients on the SQ protocol. Moderate hypoglycemia (glucose >40 and <60 mg/dL) occurred in 17 (19%) patients on the IV protocol and 24 (27%) on the SQ protocol. There were no significant differences between DM and non-DM patients within 30 d of surgery in all-cause mortality, treated HT rejection episodes, reoperation, prolonged ventilation, 30-d readmissions, ICU readmission, number of ICU hours, hospitalization days after HT, or infections. This study demonstrates that DM and non-DM patients can achieve excellent glycemic control post-HT with IV and SQ insulin protocols with similar surgical outcomes and low hypoglycemia rates.
authors.affiliation: Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Cristina
authors.initials: C
authors.lastname: Garcia
authors.forename: Amisha
authors.initials: A
authors.lastname: Wallia
authors.forename: Suruchi
authors.initials: S
authors.lastname: Gupta
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schmidt
authors.forename: Shilpa
authors.initials: S
authors.lastname: Malekar-Raikar
authors.forename: Diana
authors.initials: D
authors.lastname: Johnson Oakes
authors.forename: Grazia
authors.initials: G
authors.lastname: Aleppo
authors.forename: Kathleen
authors.initials: K
authors.lastname: Grady
authors.forename: Edwin
authors.initials: E
authors.lastname: McGee
authors.forename: William
authors.initials: W
authors.lastname: Cotts
authors.forename: Adin-Cristian
authors.initials: AC
authors.lastname: Andrei
authors.forename: Mark E
authors.initials: ME
authors.lastname: Molitch
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects* / Q000378:metabolism; D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000209:etiology / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D038321:Glycemic Index; D006331:Heart Diseases / Q000150:complications* / Q000601:surgery; D016027:Heart Transplantation / Q000009:adverse effects*; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology / Q000517:prevention & control*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents