Câmara de Souza Alexandre Barbosa, Toyoshima Marcos Tadashi Kakitani, Cukier Priscilla, Lottenberg Simão Augusto, Bolta Paula Mathias Paulino, Lima Eduardo Gomes, Serrano Júnior Carlos Vicente, Nery Marcia
Department of Endocrinology and Metabolism, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
Oncoendocrinology Service, Instituto do Câncer do Estado de São Paulo Octávio Frias de Oliveira, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.
J Diabetes Sci Technol. 2024 Aug 3:19322968241268352. doi: 10.1177/19322968241268352.
In-hospital hyperglycemia poses significant risks for patients with diabetes mellitus undergoing coronary artery bypass graft (CABG) surgery. Electronic glycemic management systems (eGMSs) like InsulinAPP offer promise in standardizing and improving glycemic control (GC) in these settings. This study evaluated the efficacy of the InsulinAPP protocol in optimizing GC and reducing adverse outcomes post-CABG.
This prospective, randomized, open-label study was conducted with 100 adult type 2 diabetes mellitus (T2DM) patients post-CABG surgery, who were randomized into two groups: conventional care (gCONV) and eGMS protocol (gAPP). The gAPP used InsulinAPP for insulin therapy management, whereas the gCONV received standard clinical care. The primary outcome was a composite of hospital-acquired infections, renal function deterioration, and symptomatic atrial arrhythmia. Secondary outcomes included GC, hypoglycemia incidence, hospital stay length, and costs.
The gAPP achieved lower mean glucose levels (167.2 ± 42.5 mg/dL vs 188.7 ± 54.4 mg/dL; = .040) and fewer patients-day with BG above 180 mg/dL (51.3% vs 74.8%, = .011). The gAPP received an insulin regimen that included more prandial bolus and correction insulin (either bolus-correction or basal-bolus regimens) than the gCONV (90.3% vs 16.7%). The primary composite outcome occurred in 16% of gAPP patients compared with 58% in gCONV ( < .010). Hypoglycemia incidence was lower in the gAPP (4% vs 16%, = .046). The gAPP protocol also resulted in shorter hospital stays and reduced costs.
The InsulinAPP protocol effectively optimizes GC and reduces adverse outcomes in T2DM patients' post-CABG surgery, offering a cost-effective solution for inpatient diabetes management.
住院期间高血糖对接受冠状动脉旁路移植术（CABG）的糖尿病患者构成重大风险。像InsulinAPP这样的电子血糖管理系统（eGMSs）有望在这些情况下规范和改善血糖控制（GC）。本研究评估了InsulinAPP方案在优化血糖控制和降低CABG术后不良结局方面的疗效。
本前瞻性、随机、开放标签研究纳入了100例CABG术后的成年2型糖尿病（T2DM）患者，将其随机分为两组：常规护理组（gCONV）和eGMS方案组（gAPP）。gAPP组使用InsulinAPP进行胰岛素治疗管理，而gCONV组接受标准临床护理。主要结局是医院获得性感染、肾功能恶化和有症状的房性心律失常的复合结局。次要结局包括血糖控制、低血糖发生率、住院时间和费用。
gAPP组的平均血糖水平较低（167.2±42.5mg/dL对188.7±54.4mg/dL；P = 0.040），血糖高于180mg/dL的患者天数较少（51.3%对74.8%，P = 0.011）。与gCONV组相比，gAPP组接受的胰岛素方案中包含更多的餐时大剂量胰岛素和校正胰岛素（大剂量校正或基础-大剂量方案）（90.3%对16.7%）。gAPP组16%的患者出现主要复合结局，而gCONV组为58%（P<0.010）。gAPP组的低血糖发生率较低（4%对16%，P = 0.046）。InsulinAPP方案还缩短了住院时间并降低了费用。
InsulinAPP方案有效优化了CABG术后T2DM患者的血糖控制并降低了不良结局，为住院糖尿病管理提供了一种具有成本效益的解决方案。
