Inadequate Blood Glucose

A study demonstrated that derangements of blood glucose control occur in patients with and without diabetes who undergo cardiac surgery. The study analyzed 8,727 adults placing them in a variety of blood glucose control categories (good= < 200 mg/dl), (moderate = 200-250 mg/dl)or (poor = >250 mg/dl). They determined that the percentage that fell in the inadequate blood glucose control categories were more likely to have renal dysfunction , heart failure, hypertension and ejection fraction < 50%. 

The study found that 52% of patients had poor control, 31% had moderate control and 8% with good control had diabetes as a diagnosis. Inadequate blood glucose control, but not diabetes, was associated with in-hospital mortality and morbidity. Inadequate control was also associated with post-operative heart attacks, and with pulmonary and renal complications in people without the diagnosis of diabetes.

The study concluded that more than 50% of patients who demonstrated moderate to poor blood glucose control after surgery for cardiac reasons were not previously identified as being diabetic. There was a statistically significant correlation between the inadequate blood sugar control, whether diabetes or not, and mortality and morbidity.

Further research needs to identify protocols and pathophysiological mechanisms for blood sugar derangements after cardiac surgery. Future research should also focus on guidelines as to how best to manage these patients. Currently, screening strategies should be emphasized, strategies for maintaining optimal blood glucose identified and the ideal target for blood glucose be established by each treating physician. 

Questions regarding the inconsistencies in diagnosing diabetes, variations in estimates of prevalence and significant variations in treatment have been brought to light. These findings also may apply to all patients admitted for major noncardiac surgery, but again, further research is needed. The impact of these findings on life expectancy and hospital resources is extremely high.

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