Hagelberg A, Ivert T, Efendić S, Ohrvik J, Anderson R E
Section for Cardiothoracic Surgery & Anaesthesiology, Karolinska Institute, Stockholm, Sweden.
Scand Cardiovasc J. 2008 Feb;42(1):71-6. doi: 10.1080/14017430701721756.
Determine if pre-emptive daily insulin glargine surpasses regular insulin when needed for glycaemic control after cardiac surgery.
Prospective, randomized study of 43 patients (scheduled for coronary artery bypass grafting) with preoperatively diagnosed diabetes (DM) or pre-DM. Lantus group received insulin glargine daily from start of surgery while Actrapid group received regular insulin (sliding scale) when needed (plasma glucose (P-glu)>10 mmol/l). Primary endpoint was percent of pre- and post-prandial P-glu values within Target Intervals: Pre-prandial P-glu: 4.5-7 mmol/l; post-prandial P-glu: 4.5-9 mmol/l. Study period 1-4 days after surgery. Tissue glucose was also measured continuously.
More than twice as many P-glu values were within Target Interval for Lantus patients as compared with Actrapid patients (p<0.001). One of 504 timed measurements was <4 mmol/l. Area under the curve for glucose>7 mmol/l was reduced by 61% by Lantus (p<0.001).
The routine protocol with pre-emptive glargine insulin studied here provides a major improvement in glycaemic control with a minimal incidence of hypoglycaemia and without an excessive increase in nursing burden.
确定在心脏手术后血糖控制需要时，术前每日注射甘精胰岛素是否优于常规胰岛素。
对43例术前诊断为糖尿病（DM）或糖尿病前期的患者（计划进行冠状动脉搭桥术）进行前瞻性随机研究。来得时组从手术开始每日接受甘精胰岛素治疗，而普通胰岛素组在需要时（血浆葡萄糖（P- glu）>10 mmol/l）接受常规胰岛素（根据血糖水平调整剂量）治疗。主要终点是目标区间内餐前和餐后P- glu值的百分比：餐前P- glu：4.5 - 7 mmol/l；餐后P- glu：4.5 - 9 mmol/l。研究期为术后1 - 4天。同时连续测量组织葡萄糖。
来得时组患者的P- glu值处于目标区间的数量是普通胰岛素组患者的两倍多（p<0.001）。504次定时测量中有1次<4 mmol/l。来得时组使葡萄糖>7 mmol/l的曲线下面积降低了61%（p<0.001）。
本文所研究的术前使用甘精胰岛素的常规方案在血糖控制方面有显著改善，低血糖发生率最低，且护理负担没有过度增加。
