Hyperinsulinemic normoglycemia decreases glucose variability during cardiac surgery

Area of Science:

• Critical Care Medicine
• Endocrinology
• Surgical Outcomes

Background:

• Increased glucose variability is linked to adverse outcomes in critically ill patients.
• Hyperinsulinemic normoglycemia offers intensive glucose control during surgery, potentially reducing variability.
• Understanding glucose variability's impact is crucial for optimizing patient care.

Purpose of the Study:

• To compare glycemic variability between hyperinsulinemic normoglycemia and standard insulin infusion in cardiac surgical patients.
• To assess the differential effect of these glucose control methods in patients with and without diabetes mellitus.

Main Methods:

• A comparative study involving 252 patients receiving hyperinsulinemic normoglycemia and 266 receiving standard insulin therapy.
• Glycemic variability was measured using average real variability (ARV), within-patient standard deviation (SD), and glucose lability index (GLI).
• Data were analyzed with significance levels of 0.05 and 0.025 for diabetic status subgroups.

Main Results:

• Hyperinsulinemic normoglycemia significantly reduced ARV in nondiabetic patients (-0.23 mg/dl/min, P < 0.001).
• No significant difference in ARV was observed between groups for diabetic patients (P = 0.07).
• Mean SD and GLI were lower with hyperinsulinemic normoglycemia overall, with a more pronounced effect in nondiabetic individuals (interaction P = 0.042).

Conclusions:

• Hyperinsulinemic normoglycemia effectively decreases glucose variability in cardiac surgical patients.
• The glucose-lowering effect is more pronounced in patients without diabetes mellitus.
• This suggests a potential benefit of hyperinsulinemic normoglycemia for specific patient populations undergoing cardiac surgery.