Nonstop Insulin Improves Vascular Surgery Outcome

Continuous perioperative insulin infusion reduces the incidence of major cardiovascular events in patients who undergo vascular surgery, researchers report.

Lead investigator Dr. Balachundhar Subramaniam stated that, “Previous studies have shown that fluctuations in blood glucose levels are a stronger predictor of mortality in certain patient populations than absolute blood glucose values.”

“Continuous intravenous administration of insulin,” he added, “is likely to be associated with less variability of blood glucose concentrations compared with either intermittent bolus subcutaneous or intravenous insulin administration.”

Dr. Subramaniam of Beth Israel Deaconess Medical Center, Boston, and colleagues randomly assigned 236 vascular surgery patients to continuous insulin infusion with a target level of 100 to 150 mg/dL or to a standard intermittent bolus approach.
Among the procedures being conducted were peripheral vascular bypass and abdominal aortic aneurysm repair, the researchers reported. 

In the control group, 12.3% reached a composite end point encompassing all-cause death, myocardial infarction, and acute congestive heart failure, compared to only 3.5% of the intervention group. Hypoglycemia was seen in 8.8% of the intervention group and 4.1% of controls. The incidence of other adverse events such as wound infections were similar between groups.

Thus, continued Dr. Subramanian, “Our results demonstrate that continuous perioperative infusion of insulin — targeting a blood glucose concentration of 100-150 mg/dL — decreases major cardiovascular events in patients undergoing major vascular surgery.”

“The variability of blood glucose concentrations in patients,” he concluded, “may play a role in producing adverse outcomes after surgery.”

Anesthesiology May 2009;110:970-977.