COMPARISON OF 3 ALGORITHMS FOR BASAL INSULIN IN TRANSITIONING FROM INTRAVENOUS TO SUBCUTANEOUS INSULIN IN STABLE PATIENTS AFTER CARDIOTHORACIC SURGERY
COMPARISON OF 3 ALGORITHMS FOR BASAL INSULIN IN TRANSITIONING FROM INTRAVENOUS TO SUBCUTANEOUS INSULIN IN STABLE PATIENTS AFTER CARDIOTHORACIC SURGERY
复制标题
DOI：
10.4158/ep11027.or
复制
发表时间：
2011-09-01
影响因子：
4.2
通讯作者：
Osei, Kwame
中科院分区：
文献类型：
--
作者：
Dungan, Kathleen;Hall, Christine;Osei, Kwame
目的：确定一种算法的有效性，该算法包含3种初始皮下注射剂量之一的地特胰岛素和灵活的餐时胰岛素和补充性门冬胰岛素，用于接受心脏手术并正在从静脉胰岛素输注过渡的稳定患者。患者拔管，未服用血管加压药，其他情况稳定，在手术后至少48小时需要每小时至少1单位的静脉注射胰岛素。患者被随机分配接受每日一次地特胰岛素治疗，剂量为静脉基础胰岛素需求量的50%、65%或80%，并根据碳水化合物摄入量接受门冬胰岛素治疗。地特胰岛素的剂量每天调整超过72 h.Results：82例患者。在50%、65%和80%剂量下，初始早晨血糖浓度为80 - 130 mg/dL的患者百分比分别为36%、63%和56%（P = 0.12）。然而，两组在24小时和72小时的平均总体葡萄糖值相似，每组分别有86%、93%和92%的患者在72小时达到80 - 180 mg/dL的平均葡萄糖浓度（P = 0.60）。低血糖（葡萄糖
Objective: To determine the effectiveness of an algorithm containing 1 of 3 initial subcutaneous doses of insulin detemir and flexible prandial and supplemental insulin aspart in stable patients who have undergone cardiac surgery and are being transitioned off intravenous insulin infusion.Methods: Patients were extubated, were not taking vasopressors, and were otherwise stable, requiring at least 1 unit per hour of intravenous insulin at least 48 hours after surgery. Patients were randomly assigned to once-daily insulin detemir at 50%, 65%, or 80% of intravenous basal insulin requirements and received insulin aspart according to carbohydrate intake. The dose of insulin detemir was adjusted daily over 72 hours.Results: Eighty-two patients were included. The percentages of patients with an initial morning glucose concentration of 80 to 130 mg/dL were 36%, 63%, and 56% of patients at the 50%, 65%, and 80% doses, respectively (P = .12). However, the mean overall glucose value at 24 and 72 hours was similar between groups, and 86%, 93%, and 92% of patients in each group, respectively, achieved a mean glucose concentration of 80 to 180 mg/dL at 72 hours (P = .60). Hypoglycemia (glucose