The intraoperative glycemic response to intravenous insulin during noncardiac surgery: a subanalysis of the DeLiT randomized trial

J Clin Anesth. 2016 Mar:29:19-29. doi: 10.1016/j.jclinane.2015.10.005. Epub 2016 Feb 2.

Abstract

Patient characteristics may affect patients' response to insulin. We examined the impact of body weight and presence of diabetes on the response to insulin during noncardiac surgery. We studied 202 patients who were enrolled in the DeLiT Trial and received intraoperative intravenous insulin. Univariable and multivariable analyses (Bonferroni corrected) assessed the relationship between patient's response to the initial intraoperative I.V. bolus of regular insulin and the factors of interest. Blood glucose concentrations decreased 8.3 ± 10mg/dL (0.46 ± 0.56mmol/L) per unit of I.V. insulin in 30minutes. The response to insulin was similar in patients with or without diabetes (adjusted mean difference [97.5% confidence interval], 0.2 [-3.9, 4.2] mg/dL, 0.01 [-0.22, 0.24] mmol/L; P = .93). No relationship was found between insulin response and body weight (P=0.38). Our results suggest that adjustment for body weight and the presence of diabetes may not improve intraoperative insulin treatment algorithms.

Trial registration: ClinicalTrials.gov NCT00433251.

Keywords: Blood-glucose; Diabetes; Hormones-insulin; Surgery.

Publication types

  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Aged
  • Blood Glucose / metabolism*
  • Body Weight / physiology
  • Diabetes Mellitus, Type 2 / blood
  • Dose-Response Relationship, Drug
  • Female
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / prevention & control
  • Hypoglycemic Agents / administration & dosage*
  • Hypoglycemic Agents / therapeutic use
  • Infusions, Intravenous
  • Insulin / administration & dosage*
  • Insulin / therapeutic use
  • Intraoperative Care / methods*
  • Male
  • Middle Aged
  • Surgical Procedures, Operative*

Substances

  • Blood Glucose
  • Hypoglycemic Agents
  • Insulin

Associated data

  • ClinicalTrials.gov/NCT00433251