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

• Published in: Diabetes research and clinical practice 2008-09, Vol.81 (3), p.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: Article
• Language: English
• 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
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2008.04.020

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.