Hyperglycaemia in patients undergoing coronary arterybypass grafting: blood glucose control methods

Authors: Lifanova L.S.

Company: Bakoulev National Medical Research Center for Cardiovascular Surgery of Ministry of Health of the Russian Federation, Rublevskoe shosse, 135, Moscow, 121552, Russian Federation

For correspondence:  Sign in or register.

Type:  Reviews


DOI: https://doi.org/10.24022/1997-3187-2019-13-3-241-249

For citation: Lifanova L.S. Hyperglycaemia in patients undergoing coronary artery bypass grafting: blood glucose control methods. Creative Cardiology. 2019; 13 (3): 241–9 (in Russ.). DOI: 10.24022/ 1997-3187-2019-13-3-241-249

Received / Accepted:  24.08.2019/04.09.2019

Keywords: coronary artery disease diabetes mellitus type 2 insulin infusion system coronary artery bypass grafting

Download
Full text:  

 

Abstract

What are adverse effects of hyperglycaemia? How we can reduce the risk of postoperative complications associated with perioperative hyperglycaemia? Over the past several decades, these issues have been dramatic. Nowadays the search for the most effective and safe method of the perioperative blood glucose control (BGC) is continuing. Perioperative hyperglycaemia associated with adverse outcomes after coronary artery bypass grafting (CABG) surgery. There are different modern methods to achieve the target glucose level. Continuous glucose monitoring systems (CGMS) allow to prevent severe hyper – and hypoglycaemia in perioperative CABG period. The use of insulin pump with CGMS reduces the rate of perioperative complications. In this article, we discuss different BGC methods and insulin pump using in patients undergoing CABG to decrease the rate of postoperative complications.

References

  1. Dedov I.I., Shestakova M.V., Vikulova O.K., Zheleznyakova A.V., Isakov M.A. Diabetes mellitus in russian federation: prevalence, morbidity, mortality, parameters of glycaemic control and structure of glucose lowering therapy according to the federal diabetes register, status. Diabetes Mellitus. 2018; 21 (3): 144–59. DOI: 10.14341/DM9686(in Russ.).
  2. Golukhova E.Z., Chebotareva G.E., Zavalikhina T.V., Magomedova N.M. Coronary interventions in patients with diabetes mellitus type 2: efficacy and safety (review). Creative Cardiology. 2008; 1: 55–66 (in Russ.)
  3. Cecilia C., Wang L., Connie N. Atherosclerotic cardiovascular disease and heart failure in type 2 diabetes – mechanisms, managevent, and clinical considerations. Circulation. 2016; 133 (24): 2459–502.
  4. Rodriguez-Araujoa G., Nakagami H. Pathophysiology of cardiovascular disease in diabetes mellitus. Cardiovascular Endocrinology & Metabolism. 2018; 7 (1): 4–9. DOI: 10.1097/XCE.0000000000000141
  5. Lazar H.L. Glycemic control during coronary artery bypass graft surgery. ISRN Cardiology. 2012; article ID 292490. DOI: 10.5402/2012/292490
  6. Lorusso R., Pentiricci S., Raddino R. et al. Influence of type 2 diabetes on functional and structural properties of coronary artery bypass conduits. Diabetes. 2003; 52: 2814–20. DOI: 10.2337/diabetes.52.11.2814
  7. Boom van den W., Schroeder R.A., Manning M.W., Setji T.L., Fiestan G.-O., Dunson D.B. Effect of A1C and glucose on postoperative mortality in noncardiac and cardiac surgeries. Diabetes Care. 2018; 41 (4): 782–8. DOI: 10.2337/dc17-2232
  8. Umpierrez G., Cardona S., Pasquel F., Jacobs S., Peng L., Unigwe M. et al. Randomized controlled trial of intensive versus conservative glucose control in patients undergoing coronary artery bypass graft surgery: GLUCO-CABG trial. Diabetes Care. 2015; 38: 1665–72. DOI: 10.2337/dc15-0303
  9. Finfer S., Chittock D.R., Su S.Y., Blair D., Foster D. Intensive versus conventional glucose control in critically ill patients. NICE-SUGAR Study Investigators. N. Engl. J. Med. 2009; 360: 1283–97. DOI: 10.1056/NEJMoa0810625
  10. Sousa-Uva M., Head S.J., Milojevic M., Collet J.-Ph., Landoni G., Castella M. et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur. J. Cardiothorac. Surg. 2017; 53 (1): 5–33. DOI: 10.1093/ejcts/ezx314
  11. Lozicki A.P. Tight blood glucose control in cardiac surgery patients. 2019. Available at: https://www. medscape.com/viewarticle/899538 (accessed 20 May 2019).
  12. Umpierrez G.E., Klonoff D.C. Diabetes technology update: use of insulin pumps and continuous glucose monitoring in the hospital. Diabetes Care. 2019; 42 (4): e66–7. DOI: 10.2337/dci18-0066
  13. Filippov Yu.I., Pekareva E.V., Mayorov A.Yu. Selected aspects of insulin pump therapy and continuous glucose monitoring in real time. Diabetes Mellitus. 2010; 4: 119–24 (in Russ.)
  14. Marics G., Koncz L., Eitler K. Effects of pH, lactate, hematocrit and potassium level on the accuracy of continuous glucose monitoring (CGM) in pediatric intensive care unit. Italian J. Pediatr. 2015; 41: 17. DOI: 10.1186/s13052-015-0122-x
  15. Bergenstal R.M., Klonoff D.C., Garg S.K. et al. Threshold-based insulin-pump interruption for reduction of hypoglycemia. N. Engl. J. Med. 2013; 369 (3): 224–32. DOI: 10.1056/NEJMoa1303576
  16. Choudhary P., Shin J., Wang Y., Evans M.L., Hammond P.J., Kerr D. et al. Insulin pump therapy with automated insulin suspension in response to hypoglycemia: reduction in nocturnal hypoglycemia in those at greatest risk. Diabetes Care. 2011; 34 (9): 2023–5. DOI: 10.2337/dc10-2411
  17. Danne T., Kordonouri O., Holder M., Haberland H., Golembowski S., Remus K., Bläsig S., Wadien T., Zierow S., Hartmann R., Thomas A. Prevention of hypoglycemia by using low glucose suspend function in sensor-augmented pump therapy. Diabetes Technol. Ther. 2011; 13 (11): 1129–34. DOI: 10.1089/dia.2011.0084
  18. Agrawal P., Welsh J.B., Kannard B., Askari S., Yang Q., Kaufman F.R. Usage and eff ectiveness of the low glucose suspend feature of the Medtronic Paradigm Veo insulin pump. J. Diabetes Sci. Technol. 2011; 5 (5): 1137–41. DOI: 22027307
  19. Umpierrez G.E., Klonoff D.C. Diabetes technology update: use of insulin pumps and continuous glucose monitoring in the hospital. Diabetes Care. 2019; 42 (4): e66–7. DOI: 10.2337/dci18-0066

About Authors

Lyubov' S. Lifanova, Cardiologist, Junior Researcher, ORCID

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery