Long-acting subcutaneously administered insulin for glycemic control immediately after cardiac surgery.

摘要

OBJECTIVE: To test the hypothesis that subcutaneous administration of basal insulin begun immediately after cardiac surgery can decrease the need for insulin infusion in patients without diabetes and save nursing time. METHODS: After cardiac surgery, 36 adult patients without diabetes were randomly assigned to receive either standard treatment (control group) or insulin glargine once daily in addition to standard treatment (basal insulin group). Standard treatment included blood glucose measurements every 1 to 4 hours and intermittent insulin infusion to maintain blood glucose levels between 100 and 150 mg/dL. The study period lasted up to 72 hours. RESULTS: There were no differences in demographics or baseline laboratory characteristics of the 2 study groups. Mean daily blood glucose levels were lower in the basal insulin group in comparison with the control group, but the difference was not statistically significant (129.3 +/- 9.4 mg/dL versus 132.6 +/- 7.3 mg/dL; P = .25). The mean duration of insulin infusion was significantly shorter in the basal insulin group than in the control group (16.3 +/- 10.7 hours versus 26.6 +/- 17.3 hours; P = .04). Nurses tested blood glucose a mean of 8.3 +/- 3.5 times per patient per day in the basal insulin group and 12.0 +/- 4.7 times per patient per day in the control group (P = .01). There was no occurrence of hypoglycemia (blood glucose level <60 mg/dL) in either group. CONCLUSION: Once-daily insulin glargine is safe and may decrease the duration of insulin infusion and reduce nursing time in patients without diabetes who have hyperglycemia after cardiac surgery.