AACC’s Expert Access Live Online Program
The Impact of Hyperglycemia and Intravenous Insulin on Cardiac Surgery Outcomes.
This month's expert is Anthony P. Furnary, MD.

Can results be achieved in the non-diabetic population using continuous insulin infusion? At our institution we have noted hyperglycemia in nearly all of our CAB patients, diabetic or not.

Anthony P. Furnary, MD: Glucose control can easily be achieved in a nondiabetic population. However, the because the nondiabetic population does not have as high a risk of infection, mortality and LOS, the results seen in a nondiabetic population are not as dramatic. However, the reductions are real they just cannot be proven to be statistically significant at this point.I agree with you that hyperglycemia occurs in 80% to 90% of CABG patients. Depending on the cutoff point one uses to start an insulin drip, most if not all patients would be on the drip in the operating room. In the Van den Berghe study, 100% of cardiac surgery patients were on an insulin infusion in the perioperative period. She used a starting point of 100 mg/dl. We use a starting point in nondiabetic patients of 140 mg/dl, and in diabetic patients of 145 mg/dl. In this scenario, 60% of our patients are on an insulin drip in the operating room and by the end of the first op-op day, that percentage is down to 40%. Nonetheless, control of hyperglycemia with TGC is imperative to achieve the best outcomes in any patient, diabetic or not.

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