Glycaemic optimization for patients with cardiac disease-A before-and-after study
Tripti Joshi1,2,3,4, Sarah-Jane Pullen1, Alison Gebuehr1
1Department of Diabetes, John Hunter Hospital, Newcastle, NSW, Australia.
International Journal of Clinical Practice
|April 20, 2018
Summary
A new guideline for managing blood sugar in diabetic patients undergoing cardiothoracic surgery or with acute coronary syndrome showed minor improvements in the cardiothoracic group. However, the guideline did not significantly impact outcomes for acute coronary syndrome patients.
Area of Science:
- Cardiology
- Endocrinology
- Healthcare Management
Background:
- Diabetes management in hospitalized patients, particularly those with cardiovascular conditions, is complex.
- Structured guidelines aim to standardize care and improve patient outcomes.
- Previous management strategies may not have been optimal for these high-risk patient groups.
Purpose of the Study:
- To evaluate the effectiveness of a structured glycaemia management guideline.
- To assess changes in glycaemic profiles and clinical outcomes.
- To compare pre- and post-implementation data for patients with diabetes undergoing cardiothoracic surgery or with acute coronary syndrome.
Main Methods:
- Retrospective before-and-after comparative analysis.
- Inclusion of 375 diabetic patients admitted for cardiothoracic surgery or acute coronary syndrome.
- Data collected during preguideline (July-December 2013) and postguideline (July-December 2014) periods.
Main Results:
- In cardiothoracic patients, mean blood glucose levels (BGL) improved post-guideline (9 to 8.4 mmol/L, P=.045).
- No significant differences were observed in readmission rates, hypoglycaemic episodes, or in-hospital mortality for either group.
- Acute coronary syndrome patients showed no significant change in mean BGL, readmissions, or mortality; however, endocrinology referrals increased.
Conclusions:
- A structured glycaemia management guideline marginally improved glycaemic control in cardiothoracic surgery patients.
- The guideline did not yield significant improvements in glycaemic profiles or outcomes for acute coronary syndrome patients.
- Further research may be needed to optimize inpatient diabetes management for cardiovascular conditions.
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