High incidence of impaired glucose regulation in patients with no known history of diabetes mellitus but with hyperglycemia after undergoing a cardiac surgical procedure.

Abstract

OBJECTIVE:

To determine the implications of the presence of hyperglycemia after a cardiac surgical procedure in patients with no history of diabetes mellitus (DM).

METHODS:

We conducted a prospective study of 50 consecutive patients with no known history of DM who underwent a cardiac surgical procedure and had postoperative hyperglycemia (plasma glucose levels > or =110 mg/dL), requiring an insulin drip to achieve tight glucose control. These patients underwent a 2-hour oral glucose tolerance test (OGTT) at 6 weeks postoperatively to determine the percentage of subjects with impaired fasting glucose (IFG), impaired glucose tolerance (IGT), or type 2 DM.

RESULTS:

Of the 50 patients, 32 (64%) were found to have persistent glucose dysregulation. On the basis of OGTT results, 20% had IFG, 16% had both IFG and IGT, 10% had only IGT, and 18% had type 2 DM. Of the patients with newly diagnosed diabetes, 89% had a 6-week post-operative fasting plasma glucose (FPG) concentration of <126 mg/dL. There was a significant correlation between the preoperative FPG levels and the 6-week postoperative 2-hour OGTT glucose levels (P<.01). No correlation was found between the 6-week postoperative FPG levels and the 2-hour OGTT glucose levels (P = .26).

CONCLUSION:

Hyperglycemia after a cardiac surgical procedure implies a high risk of persistent glucose dysregulation. Preoperative FPG levels correlated better with 2-hour OGTT results than did the 6-week postoperative FPG values, but both were insensitive markers for diagnosing type 2 DM in these patients. In our cohort, hemoglobin A1c was not predictive of abnormalities of glucose metabolism. Our data support the need for performing a postoperative OGTT in patients with no known history of DM but the presence of hyperglycemia after a cardiac operation.

• Authors: Swati Arora, Murray B Gordon
• Journal: Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists (Endocr Pract) 2009 Jul-Aug Vol. 15 Issue 5 Pg. 425-30 ISSN: 1934-2403 [Electronic] United States
• PMID: 19491079 (Publication Type: Journal Article)

Chemical References

• Blood Glucose

Topics

• Aged
• Blood Glucose (analysis)
• Cardiac Surgical Procedures (adverse effects)
• Diabetes Mellitus
• Female
• Glucose Tolerance Test
• Humans
• Hyperglycemia (blood, epidemiology, physiopathology)
• Male
• Middle Aged
• Prospective Studies