title: The intraoperative glycemic response to intravenous insulin during noncardiac surgery: a subanalysis of the DeLiT randomized trial.
abstract: Patient characteristics may affect patients' response to insulin. We examined the impact of body weight and presence of diabetes on the response to insulin during noncardiac surgery. We studied 202 patients who were enrolled in the DeLiT Trial and received intraoperative intravenous insulin. Univariable and multivariable analyses (Bonferroni corrected) assessed the relationship between patient's response to the initial intraoperative I.V. bolus of regular insulin and the factors of interest. Blood glucose concentrations decreased 8.3 ± 10mg/dL (0.46 ± 0.56mmol/L) per unit of I.V. insulin in 30minutes. The response to insulin was similar in patients with or without diabetes (adjusted mean difference [97.5% confidence interval], 0.2 [-3.9, 4.2] mg/dL, 0.01 [-0.22, 0.24] mmol/L; P = .93). No relationship was found between insulin response and body weight (P=0.38). Our results suggest that adjustment for body weight and the presence of diabetes may not improve intraoperative insulin treatment algorithms.
authors.affiliation: Associate Professor, Department of General Anesthesiology, Cleveland Clinic. Electronic address: abdelmb@ccf.org.
authors.forename: Basem B
authors.initials: BB
authors.lastname: Abdelmalak
authors.affiliation: Assistant Professor, Department of Cardiothoracic Anesthesia, Cleveland Clinic, Cleveland, OH, USA. Electronic address: duncana@ccf.org.
authors.forename: Andra E
authors.initials: AE
authors.lastname: Duncan
authors.affiliation: Clinical Research Fellow, Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: Angela_bnll@yahoo.com.
authors.forename: Angela
authors.initials: A
authors.lastname: Bonilla
authors.affiliation: System Analyst, Departments of Quantitative Health Sciences and Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: yangd@ccf.org.
authors.forename: Dongsheng
authors.initials: D
authors.lastname: Yang
authors.affiliation: Clinical Research Fellow, Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: parrai@ccf.org.
authors.forename: Ivan
authors.initials: I
authors.lastname: Parra-Sanchez
authors.affiliation: Staff Urologist, Department of Urology, Cleveland Clinic, Cleveland, OH, USA. Electronic address: Fergana@ccf.org.
authors.forename: Amr
authors.initials: A
authors.lastname: Fergany
authors.affiliation: Associate Professor, Department of General Anesthesiology, Cleveland Clinic. Electronic address: irefins@ccf.org.
authors.forename: Samuel A
authors.initials: SA
authors.lastname: Irefin
authors.affiliation: Michael Cudahy Professor, Chair, Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: ds@or.org.
authors.forename: Daniel I
authors.initials: DI
authors.lastname: Sessler
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001835:Body Weight / Q000502:physiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage* / Q000627:therapeutic use; D007430:Intraoperative Care / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013514:Surgical Procedures, Operative
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Blood-glucose; Diabetes; Hormones-insulin; Surgery