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Comparison of Perioperative Glycemic Targets and Long-term Surgical Outcomes

Results show that a stricter target of 80-110 mg/dL is not superior to 110-140 mg/dL in mortality and morbidity rate….

Hyperglycemia is common among hospitalized patients; an intensive goal in hyperglycemia management of blood glucose is 80-110 mg/dL Studies have shown increased rates of hypoglycemia without morbidity and mortality with the blood glucose of 80-110 mg/dL

The goal of this retrospective study was to examine the glucose outcomes for the first 3 days after surgery and 30 days cardiac outcomes before and after insulin protocol with a glycemic target goal of 110-140 mg/dL instead of 80-110 mg/dL. A total of 1,325 participants data were collected using the Northwestern Medicine Enterprise Data Warehouse. The fasting and pre-meal targets during subcutaneous treatment were 80-150 mg/dL for the 80-110 group and 110-180 mg/dL for the 110-140 group.

Fewer participants in the 110-140 mg/dL group experienced moderate hypoglycemia of blood glucose less than 70 mg/dL (177 vs 73, P=0.04). Though severe hypoglycemia occurred in one patient in the 80-110 group and three in the 110-140 group. The 110–140 group had higher mean postoperative BG levels compared to the 80-110 group during the intravenous insulin infusion (141 ± 15 vs. 121 ± 15 mg/dL, P < 0.001) and the subcutaneous insulin period (134 ± 24 vs. 130 ± 23 mg/dL, P < 0.001), and for 3 days postoperatively (141 ± 17 vs. 127 ± 15 mg/dL, P < 0.001).

In conclusion, the results suggest that a higher glycemic target of 110-140 mg/dL was associated with significantly fewer cases of hypoglycemia. There were no significant differences in outcomes such as mortality and morbidity between the two groups.

Practice Pearls:

  • A stricter target of 80-110 mg/dL is not superior to 110-140 mg/dL in mortality and morbidity rate.
  • A glycemic target of 110-140 mg/dL is safer due to fewer instances of hypoglycemia.
  • Similar mean glucose values in both groups.

Mulla I, Schmidt K, Cashy J, et al. “Comparison of glycemic and surgical outcomes after change in glycemic targets in cardiac surgery patients”.. September, 2014. “http://care.diabetesjournals.org/content/37/11/2960.full”