The Impact of Perioperative Hyperglycemia in Patients With and Without Diabetes Undergoing Coronary Artery Bypass Surgery: A Prospective Multicenter Observational Study

Program: Abstracts - Orals, Featured Poster Presentations, and Posters
Session: SUN 807-838-Diabetes - Diagnosis, Complications & Outcomes
Sunday, June 16, 2013: 1:45 PM-3:45 PM
Expo Halls ABC (Moscone Center)

Poster Board SUN-821
Farnoosh Farrokhi*1, Saumeth Cardona1, Obinna M Unigwe1, Ana Melikishvili1, Francisco J Pasquel1, Saira Adeel1, Dawn Smiley1, Sol Jacobs1, Limin Peng2 and Guillermo E Umpierrez*1
1Emory University School of Medicine, 2Emory Univeristy Rollins School of Public Health
This prospective multicenter study compared the prevalence and severity of hyperglycemia, the need for continuous insulin infusion (CII), and the number of perioperative complications in patients with and without diabetes (DM) undergoing CABG surgery.  A total of 200 consecutive patients (age: 63±15 yr, BMI: 30±6.5) were enrolled with admission blood glucose (BG) of 138.4±58 mg/dl and A1C: 6.8±1.9%.  Of them, 106 (53%) had a history of DM. Compared to non-DM, patients with DM were heavier (BMI: 32.3 vs. 28.1±5, p<0.001), had higher admission BG (165±65 mg/dl vs. 108.6±25 mg/dl, p<0.001) and HbA1c (7.9±2% vs. 5.6±4%, p<0.001). There were no differences in the number of surgical grafts, duration of surgery, APACHE score, or in the need for vasopressors after surgery (all p=NS).  Patients with DM had higher preoperative, (155±52 vs.109±25 mg/dl, p <0.001) and perioperative (OR and ICU) mean BG compared to non-DM patients (150±17 vs.133±14 mg/dl, p<0.001).  During the perioperative period, 100% of DM and 93% of non-DM patients developed hyperglycemia (BG>140 mg/dL); of them, a total of 100% of DM and 80% of non-DM received continuous insulin infusion (CII) (p<0.001). The mean insulin dose and duration of CII in the ICU were significantly higher in DM (129 ±138 units and 29.9±24.5 hours) compared to non-DM patients (42±46 units and 15.2±14), both p<0.001. After discontinuation of CII, 100% of patients with DM and 19% of non-DM required transition to subcutaneous (SC) basal bolus insulin regimen. The average SC insulin requirement was higher in DM compared to non-DM patients (44.9±26.2 vs. 28.6±15.3 units/day). Patients with DM had higher rates of ICU complications compared to non-DM, (23% vs. 13%, p=0.07), with greater number of complications among patients with mean perioperative BG≥140 mg/dl vs. those with BG<140 mg/dl (p=0.009).  Interestingly, the greatest number of complications were observed among non-DM with hyperglycemia (p<0.003) compared to patients with DM with hyperglycemia (p=0.63).  There were no differences in length of ICU stay or in mortality between patients with and without DM.

Conclusion: Perioperative hyperglycemia requiring CII during CABG surgery is very common in patients with and without diabetes. Patients with diabetes had higher number of complications compared to non-DM patients during the perioperative period. The presence of hyperglycemia (BG ≥ 140 mg/dl vs. <140 mg/dl) was associated with higher number of complications, particularly in those without a history of DM. Randomized controlled trials are needed to determine the importance of perioperative glycemic control on clinical outcomes in patients with and without diabetes undergoing CABG surgery.

Disclosure: DS: Investigator, Merck & Co., Investigator, Sanofi. GEU: Principal Investigator, Merck & Co., Principal Investigator, Sanofi. Nothing to Disclose: FF, SC, OMU, AM, FJP, SA, SJ, LP

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