Related Experiment Video

Updated: Jul 14, 2026

Improving IV Insulin Administration in a Community Hospital
12:08

Improving IV Insulin Administration in a Community Hospital

Published on: June 11, 2012

Strict glycemic control reduces EuroSCORE expected mortality in diabetic patients undergoing myocardial

Cosimo D'Alessandro1, Pascal Leprince, Jean Louis Golmard

  • 1Institute of Cardiology, Division of Thoracic and Cardiovascular Surgery, Centre Hospitalier Universitaire Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie-Paris, Paris, France. cosimodalessandro@wanadoo.fr

The Journal of Thoracic and Cardiovascular Surgery
|June 30, 2007
PubMed

Insights

Strict glycemic control significantly reduces mortality in diabetic patients undergoing myocardial revascularization, particularly for moderate- to high-risk individuals. This protocol offers a protective effect, lowering mortality odds by 72%.

Area of Science:

  • Cardiology
  • Diabetology
  • Surgical Outcomes

Background:

  • Diabetic patients undergoing myocardial revascularization face elevated mortality risks.
  • Effective glycemic control is crucial for improving outcomes in this patient population.

Purpose of the Study:

  • To evaluate the impact of a strict glycemic control protocol on mortality rates in diabetic patients undergoing surgical myocardial revascularization.
  • To assess the protocol's effectiveness across different risk strata.

Main Methods:

  • A prospective study involving 300 diabetic patients (protocol group, group P) receiving insulin administration.
  • A control group (group NP) of 300 diabetic patients from before protocol implementation.
  • Risk stratification using EuroSCORE (low-moderate: 0-4, moderate-high: >4) and propensity analysis for bias control.

Main Results:

  • The protocol group (P) demonstrated significantly lower observed mortality (1.3%) compared to expected mortality (4.3%, P = .01).
  • Mortality odds were reduced by 72% (odds ratio, 0.282) in the protocol group after risk adjustment.
  • The protocol showed a significant benefit in moderate- to high-risk patients (odds ratio, 0.24; P < .05).

Conclusions:

  • Strict glycemic control via an insulin protocol significantly reduces expected mortality in diabetic patients undergoing myocardial revascularization.
  • The benefits are most pronounced in moderate- to high-risk patients, highlighting the protocol's targeted efficacy.
Abstract

Related Concept Videos

Diabetes: Management and Pharmacotherapy01:15

Diabetes: Management and Pharmacotherapy

The therapy for diabetes aims to alleviate hyperglycemia-related symptoms, prevent acute metabolic decompensation, and reduce chronic end-organ complications. Glycemic control is evaluated through short-term (self-monitoring, continuous glucose monitoring) and long-term (A1c, fructosamine) metrics, enabling near real-time tracking of blood glucose levels and reflecting glycemic control over specific time frames.
Insulin remains the cornerstone of treatment for most patients with type 1 and many...
Atherosclerosis III: Management01:26

Atherosclerosis III: Management

Management of atherosclerosis involves an integrated strategy encompassing pharmacological treatment, surgical interventions, lifestyle changes, and nutrition therapy to address the multifactorial nature of the disease.Pharmacological TherapyA cornerstone of atherosclerosis management is the use of pharmacological agents. Statins, such as atorvastatin, are pivotal in inhibiting HMG-CoA reductase, an enzyme that catalyzes an initial step in cholesterol synthesis in the liver. This reduction in...
Oral Hypoglycemic Agents: &#945;-Glucosidase Inhibitors01:19

Oral Hypoglycemic Agents: α-Glucosidase Inhibitors

α-glucosidase inhibitors, including acarbose (Precose), miglitol (Glyset), and voglibose (Voglib) (primarily available in Asia), are drugs that control blood sugar levels by delaying the digestion of starch and disaccharides. They achieve this by inhibiting α-glucosidase enzymes in the intestine, which slow the absorption of carbohydrates in the intestine, which in turn leads to a prolonged release of the glucoregulatory hormone GLP-1 from intestinal L-cells.
Acarbose and miglitol are typically...
Acute Coronary Syndrome IV: Interprofessional Care01:28

Acute Coronary Syndrome IV: Interprofessional Care

IntroductionThe management of Acute Coronary Syndrome (ACS) aims to minimize myocardial damage, preserve myocardial function, and prevent complications.Initial ManagementInpatient management involves continuous cardiac monitoring, preferably in an ICU, focusing on blood pressure, serum sodium, potassium, and creatinine levels, and urine output. Ongoing pharmacologic management is crucial for stabilizing the patient.Supplemental Oxygen: Administer supplemental oxygen if oxygen saturation is...
Oral Hypoglycemic Agents: Glinides01:06

Oral Hypoglycemic Agents: Glinides

Repaglinide (Prandin) and Nateglinide (Starlix), known as glinides, are oral insulin secretagogues that stimulate insulin release from pancreatic β cells by closing the ATP-sensitive potassium channels (KATP channel). Repaglinide controls insulin release from pancreatic β cells by managing potassium efflux. It shares two binding sites with sulfonylureas and also has a unique site, indicating overlapping mechanisms of action. With a rapid onset and a 4-7 hour duration, it effectively manages...
Diabetes Mellitus: Type 2 and Gestational01:22

Diabetes Mellitus: Type 2 and Gestational

Type 2 diabetes, characterized by insulin resistance, arises when the insulin receptors on cells lose responsiveness to insulin, diminishing the cell's capacity to take up glucose, resulting in elevated blood glucose levels. To receive a diagnosis of Type 2 diabetes, a series of blood glucose tests are necessary to assess whether the blood glucose falls within normal parameters. If the result is out of the normal range, a patient may be diagnosed as prediabetic or diabetic, depending on the...