Effect of prioperative tight glucose control on the outcomes of care in patients with type 2 diabetes undergoing coronary artery bypass grafting

PURPOSE: We hypothesized that tight glycemic control in the perioperative period would reduce blood glucose levels, reduce the ICU length of stay and the hospital stay and hospital cost, decreases incidence of hyperglycemia and hypoglycemia.METHOD: We performed an interventional, quasi experimental study involving one hundred patients with diabetes mellitus undergoing primary on cardiopulmonary and off cardiopulmonary CABG. 50 patients were in the experimental group and 50 patients were in the control group. These patients were admitted to the Madani Heart Hospital during July 2009 and February 2010. Approval of the study was obtained by the Dokuz Eylül Universty School of Nursing Ethics Committe (B.30.2.BEÜ.0.Y3.02.05/593- 22.04.2009), Cardiovascular Research Center Tabriz Universty of Medical Sciences Iran, Ethics Committe (01.07.2009 ?3.1021). Written permission was obtained from the hospital director as well. An informed consent was obtained from each patient and their family members enrolled in the study. The Subcutaneous Insulin protocol and Columnar Insulin Dosing Chart was used in the experimental group and the conventional protocol was used in the control group. Data was obtained from the patients demographic and historical variables form, perioperative period Columnar Insulin Dosing Chart flow sheet and Subcutaneous Insulin order sheet The two study groups were compared on continuous variables via independent-sample tests, Mann?Whitney U, pearson ? 2 and Fisher?s exact tests, repeated measures ANOVAs with Bonferroni correction in the computer.RESULTS: The patients of experimental and control group in the firtst day of preoperative (183.34 ? 38.72; 230.75 ? 91.47 mg/dL; p=0.005) intraoperative (135.72 ? 16.74; 218.60 ? 51.25 mg/dL; p ? 0.001), ICU 1 day ( 119.79 ? 9.30; 209.75 ? 28.74 mg/dL; P ? 0 .001) ); ICU 2 day ( 122.94 ? 9.50; 183.72 ? 24.18 mg/dL; P ? 0.001); and postoperative period 3 day (136.30 ? 14.84; 200.03 ? 41.70 mg/dL; p ? 0.001) glucose control was significantly better with tight glycemic control. Tight grup had lower hospital cost (421.61 ? 60.53; 612.65 ? 173.59dollar; p ? 0.001) and a shorter ICU length of stay (45:38:34 ? 12:48:22; 63:36:22 ? 28:24:30 hour; p=0.004) and hospital length of stay (141:58 ? 36:26:19; 221:55 ? 109.16 hour; p ? 0.001). And also decreased the incidence of hyperglycemia on the perioperative period (1.66 ? 1.02;10.34 ? 5.70; p ? 0.001), but the perioperative period was be similarly in the incidence of hypoglycemia (0.10 ? 0.30; 0.24 ? 0.68; p=0.42).CONCLUSION AND IMLICATION IN PRACTICE: Perioperative tight glycemic control with Subcutaneous Insulin Orders (80-150 mgdL ) and Columnar Insulin Dosing Chart (90-140 mgdL) in diabetic coronary artery bypass graft patients decreases serum glucose levels, reduce the ICU length of stay and the hospital stay and hospital cost, decreases incidence of hyperglycemia. Tight glycemic control should become the standard of care for glycometabolic control in patients with diabetes undergoing coronary artery bypass grafting.KEY WORDS: Nursing, Coronary Artery Bypass Graft, Type 2 Diabetes Mellitus, Tight Glycemic Control, Subcutaneous Insulin Protocol, Intravenous Columnar Insulin Infusion Chart, perioperative glicemic control