Glycaemic optimization for patients with cardiac disease-A before-and-after study

Aim: To investigate if glycaemic profiles and outcomes of patients with diabetes admitted for cardiothoracic surgery or acute coronary syndrome improved after implementation of a structured glycaemia management guideline. Methods: This is a retrospective before-and-after comparative analysis of outcomes for all consecutive cardiothoracic and acute coronary syndrome patients with diabetes (N = 375), who were admitted at our tertiary-care university-affiliated hospital during the preguideline period (July-December, 2013) and the postguideline period (July-December, 2014). Results: A total of 55 cardiothoracic and 136 acute coronary syndrome patients were enrolled in the before period, and 36 cardiothoracic and 148 acute coronary syndrome patients were enrolled in the after period. In the cardiothoracic group, comparing the before vs after period, mean BGL improved (9 vs 8.4 mmol/L, P = .045), but there were no significant differences in the readmission rate (18% vs 14%; P = .6), number of hypoglycaemic episodes (1 vs 1, P = .5) or in-hospital mortality (0% vs 5.6%; P = .08). In the acute coronary syndrome group, there were no significant pre-post differences in the mean BGL (9.4 vs 10.2 mmol/L, P = .14), readmission rate (10% vs 11%; P = .8), number of hypoglycaemic episodes (1 vs 1, P = 1.0) or in-hospital mortality (5% vs 7%; P = .4). Endocrinology referrals increased significantly during the after period. Conclusions: Implementation of a structured guideline for glycaemia management on inpatient wards marginally improved glycaemic profiles in the cardiothoracic group but not in the acute coronary syndrome group.