Journal Article

The intraoperative glycemic response to intravenous insulin during noncardiac surgery: a subanalysis of the DeLiT randomized trial

Bonilla, Angela, Sessler, Daniel I., Parra-Sanchez, Ivan, Abdelmalak, Basem B., Irefin, Samuel A., Yang, Dongsheng, Fergany, Amr, Duncan, Andra E.

2016

Overview

Patient characteristics may affect patients' response to insulin. We examined the impact of body weight and presence of diabetes on the response to insulin during noncardiac surgery. We studied 202 patients who were enrolled in the DeLiT Trial and received intraoperative intravenous insulin. Univariable and multivariable analyses (Bonferroni corrected) assessed the relationship between patient's response to the initial intraoperative I.V. bolus of regular insulin and the factors of interest. Blood glucose concentrations decreased 8.3 ± 10mg/dL (0.46 ± 0.56mmol/L) per unit of I.V. insulin in 30minutes. The response to insulin was similar in patients with or without diabetes (adjusted mean difference [97.5% confidence interval], 0.2 [−3.9, 4.2] mg/dL, 0.01 [−0.22, 0.24] mmol/L; P = .93). No relationship was found between insulin response and body weight (P=0.38). Our results suggest that adjustment for body weight and the presence of diabetes may not improve intraoperative insulin treatment algorithms. •Hyperglycemia is associated with increased risk of morbidity and mortality after major surgery.•Current recommendations thus favor more moderate targets in the range of 140-180mg/dL.•The intraoperative period is unique due to the hyperglycemic surgical stress response resulting from the release of stress hormones.•Patient characteristics may affect patients’ response to insulin. Our primary goal was thus to examine the impact of body weight, and presence of diabetes on the response to insulin during non-cardiac surgery.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Anesthesia / Blood Glucose - metabolism / Blood-glucose / Body Weight - physiology / Diabetes / Diabetes Mellitus, Type 2 - blood / Dose-Response Relationship, Drug / Female / Glucose / Hormones-insulin / Humans / Hyperglycemia / Hyperglycemia - blood / Hyperglycemia - prevention & control / Hypoglycemic Agents - administration & dosage / Hypoglycemic Agents - therapeutic use / Infusions, Intravenous / Insulin / Insulin - administration & dosage / Insulin - therapeutic use / Insulin resistance / Intraoperative Care - methods / Male / Middle Aged / Pain Medicine / Surgery / Surgical Procedures, Operative