A Randomized Study in Diabetic Patients Undergoing Cardiac Surgery Comparing Computer-Guided Glucose Management With a Standard Sliding Scale Protocol

Objective: The aim of this study was to compare a standard insulin protocol with a computer-guided glucose management system to determine which method achieves tighter glucose control.

Design: A prospective, randomized trial.

Setting: A cardiothoracic intensive care unit (ICU) in a large academic medical center.

Participants: Forty patients with diabetes mellitus who were scheduled for cardiac surgery.

Interventions: After induction of anesthesia and for the first 9 hours in the ICU, each subject received a standardized infusion of a 10% glucose solution at a rate of 1.0 mL/kg/h (ideal body weight). The subjects were then randomized to have their glucose controlled by either a paper-based insulin protocol or by a computer-guided glucose management system (CG). The desired range for blood glucose was set between 90 and 150 mg/dL.

Measurements and Main Results: There were no differences between groups in baseline characteristics. Patients in the CG group spent more time in the desired range during both the intraoperative phase (49% v 27%, p = 0.001) and the ICU phase (84% v 60%, p < 0.0001). There were no statistical differences between groups in the number of hypoglycemia episodes.

Conclusions: The computer-guided glucose management system achieved tighter blood glucose control than a standard paper-based protocol in diabetic patients undergoing cardiac surgery. However, the low proportion of blood glucose recordings within the desired range in both groups during the intraoperative period reflects the challenges associated with achieving normoglycemia during cardiac surgery.

Key words: hyperglycemia, tight glucose control, computer-guided insulin protocol