Optimizing Postoperative Glucose Management in CABG Patients: Exploring Early Transition to Subcutaneous Insulin

Area of Science:

• Cardiology
• Endocrinology
• Surgical Outcomes

Background:

• Optimal glycemic control is crucial for patients undergoing coronary artery bypass graft (CABG) surgery.
• The optimal timing for switching from intravenous (IV) to subcutaneous (SC) insulin post-CABG remains undetermined.
• This study investigates early versus delayed insulin transition strategies.

Purpose of the Study:

• To compare the effects of early (postoperative day 1, POD1) versus delayed transition from IV to SC insulin.
• To evaluate the impact on glycemic control and patient outcomes after CABG surgery.

Main Methods:

• Retrospective analysis of 394 patients receiving insulin during CABG hospitalization.
• Patients were categorized into early (POD1 transition) and delayed (post-POD1 transition) groups.
• Primary outcome: euglycemia on POD1; Secondary outcomes: LOS, ICU LOS, glucose levels, hyperglycemia/hypoglycemia rates.

Main Results:

• Early transition group (n=326) showed shorter ICU and hospital length of stay (LOS) compared to the delayed group (n=68).
• No significant increase in the rate of restarting IV insulin was observed in the early transition group.
• Glycemic control and other secondary outcomes were comparable, adjusted for BMI and diabetes diagnosis.

Conclusions:

• Transitioning to SC insulin on POD1 after CABG surgery is safe and effective.
• Early insulin transition reduces length of stay in ICU and hospital.
• This strategy optimizes resource utilization without compromising patient safety or glycemic control.