The influence of pre-admission hypoglycaemic therapy on cardiac morbidity and mortality in type 2 diabetic patients undergoing major non-cardiac surgery: a prospective observational study

被引:7
作者
Bolliger, D. [1 ]
Seeberger, M. D. [1 ]
Buse, G. Lurati [1 ]
Christen, P. [2 ]
Seeberger, E. [1 ]
Ruppen, W. [1 ]
Filipovic, M. [3 ]
机构
[1] Univ Basel Hosp, Dept Anaesthesia & Intens Care Med, CH-4031 Basel, Switzerland
[2] Cantonal Hosp Lucerne, Dept Anaesthesia, Luzern, Switzerland
[3] Cantonal Hosp St Gallen, Inst Anaesthesiol, St Gallen, Switzerland
关键词
CRITICALLY-ILL PATIENTS; PERIOPERATIVE BETA-BLOCKADE; ACUTE MYOCARDIAL-INFARCTION; INTENSIVE INSULIN THERAPY; VASCULAR-SURGERY; GLUCOSE CONTROL; CARDIOVASCULAR OUTCOMES; HEART-ASSOCIATION; TRIAL; COMPLICATIONS;
D O I
10.1111/j.1365-2044.2011.06963.x
中图分类号
R614 [麻醉学];
学科分类号
100217 ;
摘要
It remains unclear whether type 2 diabetics treated with either insulin or oral hypoglycaemic agents have the same incidence of cardiac morbidity and mortality after major non-cardiac surgery. We prospectively studied 360 type 2 diabetic patients undergoing major non-cardiac surgery of which 105 were treated with insulin only, 171 were treated with oral hypoglycaemics only and 84 were treated with a combination of insulin and oral hypoglycaemics. All-cause mortality after 30 days and after 12 months was highest in the insulin (10% and 26%) and lowest in the oral hypoglycaemics group (2% and 13%; p = 0.02 and 0.007, respectively). Insulin treatment was independently associated with increased mortality after 30 days (hazard ratio 3.93; 95% CI 1.2212.64; p = 0.022) and 12 months (hazard ratio 2.03; 95% CI 1.163.58; p = 0.014) after multivariate adjustment for age, sex and the revised cardiac risk index (insulin treatment excluded). The increased mortality in insulin-treated diabetic patients may be due to a more progressive disease state in these patients rather than the treatment modality itself.
引用
收藏
页码:149 / 157
页数:9
相关论文
共 39 条
  • [1] Scientific Principles and Clinical Implications of Perioperative Glucose Regulation and Control
    Akhtar, Shamsuddin
    Barash, Paul G.
    Inzucchi, Silvio E.
    [J]. ANESTHESIA AND ANALGESIA, 2010, 110 (02) : 478 - 497
  • [2] High-dose insulin therapy attenuates systemic inflammatory response in coronary artery bypass grafting patients
    Albacker, Turki
    Carvalho, George
    Schricker, Thomas
    Lachapelle, Kevin
    [J]. ANNALS OF THORACIC SURGERY, 2008, 86 (01) : 20 - 28
  • [3] Intensive versus conventional insulin therapy: A randomized controlled trial in medical and surgical critically ill patients
    Arabi, Yaseen M.
    Dabbagh, Ousama C.
    Tamim, Hani M.
    Al-Shimemeri, Abdullah A.
    Memish, Ziad A.
    Haddad, Samir H.
    Syed, Sofia J.
    Giridhar, Hema R.
    Rishu, Asgar H.
    Al-Daker, Mouhamad O.
    Kahoul, Salim H.
    Britts, Riette J.
    Sakkijha, Maram H.
    [J]. CRITICAL CARE MEDICINE, 2008, 36 (12) : 3190 - 3197
  • [4] Randomized clinical trial of moxonidine in patients undergoing major vascular surgery
    Bolliger, D.
    Seeberger, M. D.
    Buse, G. A. L. Lurati
    Christen, P.
    Guerke, L.
    Filipovic, M.
    [J]. BRITISH JOURNAL OF SURGERY, 2007, 94 (12) : 1477 - 1484
  • [5] A Preliminary Report on the Prognostic Significance of Preoperative Brain Natriuretic Peptide and Postoperative Cardiac Troponin in Patients Undergoing Major Vascular Surgery
    Bolliger, Daniel
    Seeberger, Manfred D.
    Buse, Giovanna A. L. Lurati
    Christen, Peter
    Rupinski, Brian.
    Guerke, Lorenz
    Filipovic, Miodrag
    [J]. ANESTHESIA AND ANALGESIA, 2009, 108 (04) : 1069 - 1075
  • [6] Cardiac complications and mortality rates in diabetic patients following non-cardiac surgery in an Australian teaching hospital
    Bolsin, S. N. C.
    Raineri, F.
    Lo, S. K.
    Cattigan, C.
    Arblaster, R.
    Colson, M.
    [J]. ANAESTHESIA AND INTENSIVE CARE, 2009, 37 (04) : 561 - 567
  • [7] Intensive insulin therapy and pentastarch resuscitation in severe sepsis
    Brunkhorst, Frank M.
    Engel, Christoph
    Bloos, Frank
    Meier-Hellmann, Andreas
    Ragaller, Max
    Weiler, Norbert
    Moerer, Onnen
    Gruendling, Matthias
    Oppert, Michael
    Grond, Stefan
    Olthoff, Derk
    Jaschinski, Ulrich
    John, Stefan
    Rossaint, Rolf
    Welte, Tobias
    Schaefer, Martin
    Kern, Peter
    Kuhnt, Evelyn
    Kiehntopf, Michael
    Hartog, Christiane
    Natanson, Charles
    Loeffler, Markus
    Reinhart, Konrad
    [J]. NEW ENGLAND JOURNAL OF MEDICINE, 2008, 358 (02) : 125 - 139
  • [8] Primary prevention of cardiovascular diseases in people with diabetes mellitus - A scientific statement from the American Heart Association and the American Diabetes Association
    Buse, John B.
    Ginsberg, Henry N.
    Bakris, George L.
    Clark, Nathaniel G.
    Costa, Fernando
    Eckel, Robert
    Fonseca, Vivian
    Gerstein, Hertzel C.
    Grundy, Scott
    Nesto, Richard W.
    Pignone, Michael P.
    Plutzky, Jorge
    Porte, Daniel
    Redberg, Rita
    Stitzel, Kimberly F.
    Stone, Neil J.
    [J]. CIRCULATION, 2007, 115 (01) : 114 - 126
  • [9] Preoperative NT-proBNP and CRP predict perioperative major cardiovascular events in non-cardiac surgery
    Choi, J-H
    Cho, D. K.
    Song, Y-B
    Hahn, J-Y
    Choi, S.
    Gwon, H-C
    Kim, D-K
    Lee, S. H.
    Oh, J. K.
    Jeon, E-S
    [J]. HEART, 2010, 96 (01) : 56 - 62
  • [10] Variability of blood glucose concentration and short-term mortality in ctitically ill patients
    Egi, Moritoki
    Bellomo, Rinaldo
    Stachowski, Edward
    French, Craig J.
    Hart, Graerne
    [J]. ANESTHESIOLOGY, 2006, 105 (02) : 244 - 252