scholarly journals Perioperative glycemic control in patients with coronary artery disease and diabetes mellitus type 2 undergoing coronary artery bypass grafting: results of pilot study

2020 ◽  
Vol 23 (1) ◽  
pp. 37-45
Author(s):  
Elena Z. Golukhova ◽  
Naida I. Bulaeva ◽  
Liubov S. Lifanova ◽  
Yaroslava V. Pugovkina
Keyword(s):  
Coronary Artery ◽  
Insulin Therapy ◽  
Insulin Pump ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Hs Crp ◽  
Artery Disease ◽  
Bolus Insulin

BACKGROUND: According to different studies, diabetes mellitus type 2 (DM2) is associated with higher mortality after undergoing coronary artery bypass grafting (CABG). Perioperative hyperglycaemia, even in non-DM2 patients, is associated with adverse outcomes after CABG. Thus, successful perioperative blood glucose control (BGC) is mandatory to reduce the risk of death and postoperative complications. Nowadays, the most effective method for BGC in the operating room is still unknown. AIMS: To assess the continuous glucose monitoring (CGM) efficacy in association with insulin pump therapy in patients with coronary artery disease (CAD) and DM2 undergoing CABG in intra- and early postoperative periods. METHODS: The study involved 97 patients undergoing isolated CABG. Patients were divided into two groups: 48 patients with DM2 and 49 patients without DM2. In both groups of patients, we used CGM in intra- and early postoperative periods (72 hours). In some patients with DM2, CGM was associated with insulin pump therapy (MiniMed Paradigm Veo 554/754) to successfully control postoperative glucose level. Besides commonly used tests (such as HbA1C and lipid profile), we analysed high sensitive C-reactive protein (hs-CRP) levels before surgery, and then at 1 hour, 12 hours and 7 days after CABG in order to estimate their prognostic value. RESULTS: During the 48 hours after CABG, there was a trend towards having higher glucose levels in both groups of patients with and without DM2 according to CGM. In patients with DM2, the glucose level was significantly increased (р0,05). Insulin pump therapy resulted in glycemic control improvement in early follow-up (72 hours). Moreover, there were no hypoglycaemic episodes in patients on insulin pump therapy and also in patients prescribed bolus insulin therapy. We revealed the trend towards lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p=0,1). Hs-CRP level was lower in patients with DM2 who were on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р0,05). This most likely confirms that insulin pump therapy decreases systemic inflammatory response. CONCLUSIONS: Thus, we demonstrated the CGM feasibility, safety and efficacy in association with insulin pump therapy in patients with DM2 undergoing CABG.

scholarly journals Should We Monitor Glucose and Biomarkers in Diabetics over Heart Surgery?

2021 ◽  
Vol 10 (15) ◽  
pp. 3399
Author(s):  
Elena Z. Golukhova ◽  
Ljubov S. Lifanova ◽  
Yaroslava V. Pugovkina ◽  
Marina V. Grigoryan ◽  
Naida I. Bulaeva
Keyword(s):  
Insulin Therapy ◽  
Postoperative Period ◽  
Glucose Control ◽  
Insulin Pump ◽  
Early Postoperative Period ◽  
Insulin Pump Therapy ◽  
Diabetic Patients ◽  
Pump Therapy ◽  
Hs Crp ◽  
Bolus Insulin

Hyperglycemia is associated with adverse outcomes after coronary artery bypass grafting (CABG). While there is a consensus that blood glucose control may benefit patients undergoing CABG, the role of biomarkers, optimal method, and duration of such monitoring are still unclear. The aim of this study is to define the efficacy of a continuous glucose monitoring system (CGMS) and link it to pro-inflammatory biomarkers while on insulin pump therapy in diabetic patients undergoing CABG. We prospectively assessed CGMS for 72 h in 105 patients including 52 diabetics undergoing isolated CABG. In diabetics, CGMS was connected to an insulin pump for precise glucose control. On top of conventional biomarkers (HbA1C, lipid profile), high sensitive C-reactive protein (hs-CRP), Regulated upon Activation Normal T cell Expressed and presumably Secreted (RANTES), and leptin levels were collected before surgery, 1 h, 12 h, 7 days, and at 1 year after CABG. Overall, CGMS revealed high glucose independently from underlying diabetes during first 48 h following CABG but was higher (р < 0.05) in diabetics. The insulin pump improved glycemic control over early follow-up (72 h) post-CABG. There were no hypoglycemic episodes in patients on insulin pump therapy and those receiving bolus insulin therapy. We revealed a lower rate of postpericardiotomy syndrome (PCTS) in patients on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (p = 0.03). Hs-CRP and RANTES levels were lower in patients with T2DM on insulin pump therapy compared to patients prescribed bolus insulin therapy in the early postoperative period (р < 0.05). It is most likely due to the fact that insulin pump therapy decreases systemic inflammatory response. Further controlled trials should assess whether CGMS improves outcomes after cardiac surgery.

scholarly journals Model-Based Tool for Personalized Adjustment of Basal Insulin Supply in Patients With Intensified Conventional Insulin Therapy

2019 ◽  
Vol 13 (5) ◽  
pp. 928-934
Author(s):  
Lutz Vogt ◽  
Andreas Thomas ◽  
Gert Fritzsche ◽  
Peter Heinke ◽  
Klaus-Dieter Kohnert ◽  
...  
Keyword(s):  
Insulin Therapy ◽  
Basal Insulin ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Insulin Dosage ◽  
Treatment Team ◽  
Pump Therapy ◽  
Modeling Tool ◽  
Conventional Insulin Therapy ◽  
Model Based

Background: The decisive factor in successful intensive insulin therapy is the ability to deliver need-based-adjusted nutrition-independent insulin dosages at the closest possible approximation to the physiological insulin level. Because this basal insulin requirement is strongly influenced by the patient’s lifestyle, its subtlety is of great importance. This challenge is very different between patients with type 1 diabetes and those with insulin-dependent type 2 diabetes. Furthermore, it is more difficult to finetune a basal insulin dosage with intensified conventional insulin therapy (ICT), due to delayed insulin delivery, compared to insulin pump therapy, which provides continuous delivery of small doses of exclusively short-acting insulin. In all cases, the goal is to achieve an optimal basal delivery rate. Method: We hypothesized that this goal could be achieved with a modeling tool that determined the optimal basal insulin supply based on the patient’s anamnestic data and monitored glucose values. This type of modeling tool has been used in health insurance programs in Germany to improve insulin control in patients that receive ICT. Results: Our retrospective data analysis showed that this modeling tool provided a significant improvement in metabolic control, significant reductions in HbA1c and Q scores, and improved time-in-range values, with reduced daily insulin levels. Conclusion: The model-based basal rate test could provide additional data of the actual effect of the basal insulin adjustment in intensified insulin treated diabetes to the physician or treatment team.

scholarly journals Use of Automated Bolus Calculators for Diabetes Management

2010 ◽  
Vol 9 (2) ◽  
pp. 92 ◽  
Author(s):  
Frank L Schwartz ◽  
Cynthia R Marling ◽  
◽  
Keyword(s):  
Insulin Therapy ◽  
Glucose Control ◽  
Diabetes Management ◽  
Insulin Pump ◽  
Smart Phone ◽  
Glycated Haemoglobin ◽  
Insulin Pump Therapy ◽  
Pump Therapy ◽  
Numeracy Skills ◽  
Patients With Diabetes

Fewer than 30 % of patients with diabetes who are on insulin therapy achieve target glycated haemoglobin (HbA1c) levels. Automated bolus calculators (ABCs) are now almost universally used for patients on insulin pump therapy to calculate pre-meal insulin doses. Use of ABCs in glucose monitors and smart phone applications have the potential to improve glucose control in a larger population of individuals with diabetes on insulin therapy by overcoming the fear of hypoglycaemia and assisting those with low numeracy skills.

Automated Bolus Calculators and Connected Insulin Pens: A Smart Combination for Multiple Daily Injection Insulin Therapy

2021 ◽  
pp. 193229682110626
Author(s):  
David T Ahn
Keyword(s):  
Health Care Professionals ◽  
Insulin Pump ◽  
Insulin Pump Therapy ◽  
Daily Injection ◽  
Regulatory Oversight ◽  
Pump Therapy ◽  
Multiple Daily Injection ◽  
Insulin Pens ◽  
Bolus Insulin ◽  
Glycemic Outcomes

Although automated bolus calculators (ABCs) have become a mainstay in insulin pump therapy, they have not achieved similar levels of adoption by persons with diabetes (PWD) using multiple daily injections of insulin (MDI). Only a small number of blood glucose meters (BGMs) have incorporated ABC functionality and the proliferation of unregulated ABC smartphone apps raised safety concerns and eventually led to Food and Drug Administration (FDA)–mandated regulatory oversight for these types of apps. With the recent introduction of smartphone-connected insulin pens, manufacturer-supported companion ABC apps may offer an ideal solution for PWD and health care professionals that reduces errors of mental math when calculating bolus insulin dosing, increases the quality of diabetes data reporting, and improves glycemic outcomes.

scholarly journals Coronary artery bypass grafting in patients with coronary artery disease and COVID-19: search for an optimal strategy

2021 ◽  
Vol 26 ◽  
pp. 4342
Author(s):  
D. V. Kuznetsov ◽  
A. A. Gevorgyan ◽  
V. V. Novokshenov ◽  
A. V. Kryukov ◽  
M. V. Polyaeva ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Cardiac Surgery ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Coronary Artery Bypass ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Bypass Grafting ◽  
Artery Bypass Grafting ◽  
Artery Disease

Extent of cardiac surgery aid has dropped significantly globally due to reallocation of health care resources due to COVID-19 pandemic.Aim. To evaluate the results of chosen management strategy for patients with coronary artery disease (CAD) and COVID-19 manifested in the early postoperative period after coronary artery bypass grafting.Material and methods. We present our experience of treating 19 patients with CAD and COVID-19 manifested in the early postoperative period after coronary artery bypass grafting. The main symptoms of COVID-19 in these patients were high-grade fever, severe general weakness, shortness of breath, and decreased blood oxygen saturation. Laboratory data showed significant increases in fibrinogen, C-reactive protein, ferritin, procalcitonin, and D-dimer levels. In all patients, according to the chest computed tomography, a picture of unilateral or bilateral multisegmental pneumonia in the form of ground-glass opacity areas was determined. The damaged lung area varied from 10% to 55%.Results. Patients were treated in accordance with the Russian guidelines, followed by transfer to continue therapy in specialized infectious diseases hospitals. Sixteen patients transferred to infectious diseases hospitals were subsequently discharged from in a satisfactory condition. Three patients died from various complications of COVID-19 (mortality rate, 16%).Conclusion. The development of new screening strategies, standard guidelines and protocols for the management of cardiac surgery patients in a pandemic will contribute to an earlier detection of COVID-19 and, accordingly, a timely change in treatment strategy.

scholarly journals Сardiac troponin I for assessment of myocardial damage and prediction of complications in cardiac surgery patients

2021 ◽  
pp. 15-19
Author(s):  
T. A. Sheshurina ◽  
V. V. Dorofeykov ◽  
T. V. Vavilova
Keyword(s):  
Cardiac Surgery ◽  
Coronary Artery ◽  
Troponin I ◽  
Artery Bypass ◽  
Myocardial Damage ◽  
Early Postoperative Period ◽  
Replacement Surgery ◽  
Artery Disease ◽  
Prediction Of Complications ◽  
Valve Replacement Surgery

The study analysed the level of troponin I (Tn) in the blood in patients with coronary artery disease after coronary artery bypass grafting in comparison with patients after aortic valve replacement surgery. The dynamics of troponin in the early postoperative period was studied, a parallelism was established between the occurrence of complications after surgery and the degree of myocardial damage. A new method has been developed for assessing the degree of intraoperative myocardial damage and the risk of complications using the «index of myocardial damage», the Tn level is determined twice after the operation, in the period up to 6 hours – Tn early and 12–24 hours later – Tn late, the index is calculated as the ratio of Tn late one to Tn early one. A correlation analysis of the «index» with other laboratory parameters was carried out, as a result of which no significant correlations were found, which indicates the absence of duplication and the significance of the developed indicator for assessing myocardial damage after cardiac surgery.

scholarly journals The possibilities of using levosimendan in medical preparation to Coronary Artery Bypass Grafting in coronary artery disease patients with low left ventricular ejection fraction

2020 ◽  
Vol 92 (1) ◽  
pp. 43-48
Author(s):  
V P Gazizova ◽  
E E Vlasova ◽  
E V Dzybinskaya ◽  
V V Gramovich ◽  
O V Stukalova ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Early Postoperative Period ◽  
Left Ventricular Ejection ◽  
Drug Preparation ◽  
Ventricular Ejection Fraction ◽  
Artery Disease

Aim: to work out an approach of preoperative drug preparation for CAD patients with low LVEF and varying degrees of compensation for CHF, to study the possibility of using levosimendan (L) in this preparation. Materials and methods. We studied 82 patients with severe angina pectoris, multivascular coronary disease, extensive postinfarction zone, LVEF ≤35%, chronic heart failure and proven viable myocardium, which performed CABG. All patients received long - term standard CHF therapy before surgery: loop diuretic, ACE/ARA, beta - blocker, aldosterone antagonist. In the first, retrospective part of the study (39 pts), it was determined which factors could be associated with perioperative AHF. In the second, prospective part (43 pts), the course of the operation and the early postoperative period in patients with compensated and uncompensated heart failure were compared; uncompensated pts received L 2 days before surgery in addition to standard therapy. The third, retro - prospective part of the study (37 pts) was the assessment of operation outcome in patients only with uncompensated pre - operative CHF, but with different preoperative drug preparation. Results. Statistically significant direct influence on the perioperative AHF development was provided by the combined clinical sign - venous pulmonary congestion+orthopnea (p

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