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Intensive glycemic control after heart transplantation is safe and effective for diabetic and non-diabetic patients

Cristina Garcia1, Amisha Wallia, Suruchi Gupta

  • 1Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.

Clinical Transplantation
|April 12, 2013
PubMed

Insights

Diabetic and non-diabetic patients undergoing heart transplant (HT) achieved similar glycemic control and surgical outcomes using intravenous and subcutaneous insulin protocols. Both groups experienced low rates of hypoglycemia, demonstrating effective management strategies.

Area of Science:

  • Cardiology
  • Endocrinology
  • Transplantation Medicine

Background:

  • Diabetic patients often face increased risks post-heart transplant (HT), including mortality, infection, and rejection.
  • Effective glycemic control is crucial for improving outcomes in diabetic patients after HT.

Purpose of the Study:

  • To compare glycemic control and surgical outcomes between diabetic (DM) and non-diabetic (non-DM) patients undergoing HT.
  • To evaluate the safety and efficacy of intravenous (IV) and subcutaneous (SQ) insulin protocols in post-HT glycemic management.

Main Methods:

  • Retrospective chart review of adult patients (DM, n=26; non-DM, n=66) undergoing HT between June 2005 and July 2009.
  • Implementation of IV and SQ insulin protocols with a target glucose range of 80-110 mg/dL.
  • Comparison of glycemic levels, hypoglycemia rates, and 30-day surgical outcomes between DM and non-DM groups.

Main Results:

  • No significant differences in mean glucose levels were observed between DM and non-DM patients on either IV or SQ insulin protocols.
  • Severe hypoglycemia (<40 mg/dL) was rare, occurring only in 3 non-DM patients on the SQ protocol.
  • Moderate hypoglycemia (40-60 mg/dL) occurred in 19% of patients on IV and 27% on SQ protocols.
  • No significant differences in 30-day mortality, rejection episodes, reoperation, prolonged ventilation, readmissions, ICU hours, hospitalization days, or infections were found between DM and non-DM patients.

Conclusions:

  • Diabetic and non-diabetic patients can achieve excellent glycemic control post-heart transplant using IV and SQ insulin protocols.
  • These insulin protocols are associated with similar surgical outcomes and low hypoglycemia rates in both diabetic and non-diabetic heart transplant recipients.
  • The findings support the use of standardized insulin protocols for effective post-HT glycemic management in diabetic and non-diabetic populations.

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