Abstract | STUDY OBJECTIVE: To evaluate three evening insulin glargine dosing strategies for achievement of target (100-179 mg/dL; 5.5 - 9.8 mmol/L) and widened (80-249 mg/dL; 4.4 - 13.7 mmol/L) preoperative fasting blood glucose (FBG) ranges on the day of surgery. DESIGN: Prospective, randomized, open trial. SETTING: Preoperative units at two sites of a suburban hospital system. PATIENTS: 401 adult, ASA physical status 3 and 4 patients with type 1 and type 2 diabetes, undergoing elective noncardiac surgery. INTERVENTIONS: Patients were divided into two groups according to absence of daily rapid-acting/ short-acting insulin ( insulin glargine-only group) or presence of daily rapid-acting/ short-acting insulin ( insulin glargine plus bolus group). Subjects were then randomized to three evening insulin glargine dosing strategies: (a) take 80% of usual dose, (b) call physician for dose, or (c) refer to dosing table, based on self-reported usual FBG and insulin regimen. In the prehospital setting, patients administered the instructed insulin glargine dose on the evening before surgery. MEASUREMENTS: Venous blood glucose values were recorded in the preoperative holding area on the day of surgery. MAIN RESULTS: No significant differences in target preoperative FBG achievement were detected among strategies in the insulin glargine-only group (n = 174) or the insulin glargine plus bolus group (n = 227). In widened preoperative FBG achievement, no significant difference was noted among strategies in the insulin glargine-only group. In the insulin glargine plus bolus group, fewer subjects following the dosing table had FBG > 249 mg/dL (> 13.7 mmol/L; P = 0.031). CONCLUSIONS:
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Authors | Solomon I Rosenblatt, Tamra Dukatz, Rebecca Jahn, Craig Ramsdell, Alla Sakharova, Michelle Henry, Marina Arndt-Mutz, Virginia Miller, Kathleen Rogers, Mamtha Balasubramaniam |
Journal | Journal of clinical anesthesia
(J Clin Anesth)
Vol. 24
Issue 8
Pg. 610-7
(Dec 2012)
ISSN: 1873-4529 [Electronic] United States |
PMID | 23122972
(Publication Type: Comparative Study, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
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Copyright | Copyright © 2012 Elsevier Inc. All rights reserved. |
Chemical References |
- Blood Glucose
- Hypoglycemic Agents
- Insulin, Long-Acting
- Insulin Glargine
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Topics |
- Aged
- Blood Glucose
(drug effects)
- Diabetes Mellitus, Type 1
(drug therapy)
- Diabetes Mellitus, Type 2
(drug therapy)
- Dose-Response Relationship, Drug
- Elective Surgical Procedures
(methods)
- Female
- Humans
- Hyperglycemia
(prevention & control)
- Hypoglycemic Agents
(administration & dosage, therapeutic use)
- Insulin Glargine
- Insulin, Long-Acting
(administration & dosage, therapeutic use)
- Male
- Middle Aged
- Preoperative Care
(methods)
- Prospective Studies
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