Efficacy and safety of modified Yale insulin infusion protocol in Japanese diabetic patients after open-heart surgery

Abstract To our knowledge, there is currently no insulin infusion protocol for critically ill patients especially designed for Asian diabetics although many such protocols are used in Western countries. In this study, we modified the Yale insulin infusion protocol taking into consideration the chara...

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Published in:	Diabetes research and clinical practice Vol. 81; no. 3; pp. 296 - 302
Main Authors:	Tamaki, Motoyuki, Shimizu, Tomoaki, Kanazawa, Akio, Tamura, Yoshifumi, Hanzawa, Ayame, Ebato, Chie, Itou, Chiharu, Yasunari, Eisuke, Sanke, Haruna, Abe, Hiroko, Kawai, Junko, Okayama, Kaede, Matsumoto, Kazuhisa, Komiya, Koji, Kawaguchi, Minako, Inagaki, Noriko, Watanabe, Takahiro, Kanazawa, Yoshie, Hirose, Takahisa, Kawamori, Ryuzo, Watada, Hirotaka
Format:	Journal Article
Language:	English
Published:	Ireland Elsevier Ireland Ltd 01-09-2008
Subjects:	Aged Blood Glucose - drug effects Blood Glucose - metabolism Cardiac Surgical Procedures Critical Illness - therapy Diabetes Diabetic Angiopathies - drug therapy Diabetic Angiopathies - surgery Elective Surgical Procedures Endocrinology & Metabolism Female Humans Hyperglycemia Hypoglycemic Agents - therapeutic use Insulin - therapeutic use Insulin infusion protocol Insulin Infusion Systems - standards Intensive care unit Male Middle Aged Postoperative Period Safety Treatment Outcome modified Yale insulin infusion protocol body mass index Insulin infusion protocol MY American Association of Clinical Endocrinologists Hyperglycemia empirical blood glucose control American Diabetes Association ICU intensive care unit Diabetes AACE ADA EC BMI Intensive care unit
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Summary:	Abstract To our knowledge, there is currently no insulin infusion protocol for critically ill patients especially designed for Asian diabetics although many such protocols are used in Western countries. In this study, we modified the Yale insulin infusion protocol taking into consideration the characteristics of Japanese diabetics and hospital environment. We tested the modified protocol in 40 type 2 diabetic patients after elective open-heart surgery (MY group) comparing with 35 type 2 diabetic patients under empirical blood glucose control (EC group). Analyses of 1656 blood glucose measurements during insulin infusion revealed that percentage of samples that showed achievement of target blood glucose level (80–140 mg/dl) was higher under MY (78 ± 15%, n = 870) than EC (57 ± 23%, n = 786, p < 0.0001). On the other hand, the percentage of samples in which blood glucose was less than 60 mg/dl was comparable in the two groups (MY: 0.5 ± 5.9‰, EC: 5.1 ± 18.5‰). None of the patients with hypoglycemia showed significant clinical adverse effects. In conclusion, our modified Yale insulin infusion protocol is effective and safe for tight blood glucose control in Japanese diabetic patients after open-heart surgery.
Bibliography:	ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-News-1 ObjectType-Feature-3 content type line 23
ISSN:	0168-8227 1872-8227
DOI:	10.1016/j.diabres.2008.04.020