Intensive insulin therapy, with the help of a patient-specific IV insulin dosing platform, helped reduce post-cardiac surgery complications, according to a new study from Emory University.
The trial, conducted by Emory, leveraged the Greenville, S.C.-based Glytec Systems’ Glucommander IV, an FDA-cleared solution which establishes glycemic control via accurate, patient-specific insulin dosing. A total of 302 patients were looked at after coronary artery bypass graft (CABG) surgery. Results demonstrated that providing more precise insulin dosing via the Glucommander IV led to improved glycemic control and a significant reduction in the rate of hypoglycemia, which is a common side effect of intensive insulin therapy in patients undergoing cardiac surgery. Hyperglycemia is common in patients undergoing cardiac surgery, reported in 60 to 90 percent of patients with a known history of diabetes and in more than half of patients without diabetes.
Using the platform’s predictive dosing algorithms for patients requiring IV insulin, the midpoint of the prescribed target range for both targets was able to be achieved throughout this study, and rates of hypoglycemia were significantly lower than that observed in previous randomized clinical trials in the ICU. Only 12 patients (8 percent) during continuous insulin infusion (CII) in the intensive care group and five patients (3 percent) in the conservative group experienced mild hypoglycemia (<70 mg/dL), and no patients experienced a glucose value <40 mg/dL. Further, glucose average concentration was lower in patients randomized to the intensive insulin therapy than those in the conservative treatment group.
"The results of the GLUCO-CABG trial indicate that glucose control in patients with type 2 diabetes undergoing CABG surgery is associated with a reduction in post-surgery complications,” Guillermo E. Umpierrez, M.D., the lead author of the study, said in a statement. “The Glucommander IV algorithm allowed us to randomize patients to different glucose targets with a low rate of hypoglycemic events. The study found the rates of complications were reduced by 20 percent in patients with diabetes and 40 percent in non-diabetic patients with hyperglycemia compared to conservative insulin therapy.”