Performance of a 2-step insulin infusion protocol with adjustment of insulin doses for Asians in the medical intensive care unit following cardiothoracic surgery
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Most previous insulin infusion protocols are titrated for Westerners and are not simple to follow. In this study, we tested the efficacy and safety of our simple insulin infusion protocol utilizing lower insulin doses for Asians.
A total of 152 patients with type 2 diabetes undergoing cardiothoracic surgery were included. After surgery, blood glucose (BG) was initially managed according to our algorithm protocol, and subsequently by the post-algorithm protocol. Insulin infusion rates in the algorithm protocol were titrated in two steps according to (1) current BG levels and (2) the difference between current and previous BG levels. In the post-algorithm protocol, insulin lispro was injected subcutaneously in addition to intravenous insulin infusion according to BG levels. The efficacy was assessed as achievement rates of two target BG ranges (140–199 and 80–199 mg/dL), and safety was assessed as hypoglycemia (< 70 mg/dL) and protocol error rates.
With the use of the algorithm protocol, 58.7% of 1749 BG measurements achieved a range of 140–199 mg/dL, and 95.9% achieved levels within the 80–199 mg/dL range. Hypoglycemia and protocol error rates were 0.47 and 0.51%, respectively. With the post-algorithm protocol, 48.7 and 98.3% of 898 BG measurements achieved each target range. Hypoglycemia and protocol error rates were 0.78 and 0.22%, respectively. Severe hypoglycemia (< 40 mg/dL) was not observed.
Our insulin infusion protocol seems to be efficacious, safe, and widely feasible for Asian patients because of its simplicity and lower insulin dose.
KeywordsInsulin Insulin infusion protocol Surgical diabetes Hypoglycemia Cardiac surgery Intensive care unit
Compliance with ethical standards
Conflict of interest
All the authors declare that they have no conflict of interest.
Yoshihiko Nishio has received honoraria for scientific lectures from Eli Lilly. Kazuma Ogiso, Nobuyuki Koriyama, Takahiko Obo, Akinori Tokito, and Takayuki Ueno have nothing to disclose.
Human rights statement
All the procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (National Hospital Organization Kagoshima Medical Center, Ethics Committee, date of approval: 6 February 2017, approval no. 28-71) and with the Helsinki Declaration of 1964 and later versions.
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