Association of preoperative glucose concentration with myocardial injury and death after non-cardiac surgery (GlucoVISION): a prospective cohort study

Punthakee, Zubin; Iglesias, Pilar Paniagua; Alonso‐Coello, Pablo; Gich, Ignasi; India, Inmaculada; Málaga, Germán; Jover, Ruben Diaz; Gerstein, Hertzel C.; Devereaux, P.J.

doi:10.1016/s2213-8587(18)30205-5

Cited by 29 publications

(28 citation statements)

References 31 publications

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“…[5][6][7] T2DM was an independent predictor for mortality after cardiac surgery and non-cardiac surgery. 8,9 Compared with non-diabetic populations, patients with T2DM are more likely to have postoperative pneumonia after surgery. Spanish Hospital Discharge Database shows that T2DM patients had a 21% higher incidence of postoperative pneumonia than nondiabetic patients in 2001-2015.…”

Section: Introductionmentioning

confidence: 99%

<p>The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery</p>

Liu

et al. 2019

DMSO

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The aim of the study was to explore the relationship between type 2 diabetes (T2DM) and postoperative pneumonia, and the effects of T2DM and postoperative pneumonia on the mortality in inpatients with surgery. Methods: A retrospective study was conducted on 43,174 inpatients with surgery in The First Hospital of Qinhuangdao. These patients were divided into four groups according to T2DM and postoperative pneumonia, Group A subjects without T2DM and postoperative pneumonia, Group B subjects with T2DM only, Group C subjects with postoperative pneumonia only and Group D subjects with T2DM and postoperative pneumonia. Inhospital mortality was collected. Results: The incidences of postoperative pneumonia were higher in patients with T2DM than patients without T2DM (T2DM 3.2% vs Non-diabetes 1.7%, χ 2 =36.219, P<0.001). The mortalities were 0.3% in Group A, 0.3% in Group B, 4.6% in Group C and 8.6% in Group D. In multiple logistic regression analysis, adjusted for sex, age, emergency admissions, coronary heart disease, heart failure, chronic kidney disease, hypoproteinemia, stroke and transient ischemic attack, the mortalities of Group C and Group D were 4.515 (95% CI: 2.779～7.336, P<0.001) times and 8.468 (95% CI: 3.567～20.099, P<0.001) times than the mortality of Group A. Conclusion: T2DM is susceptible to postoperative pneumonia. The mortality increased in patients with postoperative pneumonia. When patients with T2DM and postoperative pneumonia at the same time, the mortality increased further. In T2DM patients with postoperative pneumonia, perioperative management should be improved for patient safety.

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Section: Introductionmentioning

confidence: 99%

<p>The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery</p>

Liu

et al. 2019

DMSO

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“…Additionally, the American Heart Association statement from 2018 recommends considering intensive glucose control in patients with a glycemia level above 180 mg/dL. 31,32 However, how strictly the glucose levels should be managed to avoid deleterious effects of hypoglycemia in patients with ACS remains controversial.…”

Section: Discussionmentioning

confidence: 99%

Glycemic variability in type 2 diabetes mellitus and acute coronary syndrome: liraglutide compared with insulin glargine: a pilot study

et al. 2020

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Objective To explore the glucagon-like peptide-1 analogue liraglutide in the hospital setting in patients with type 2 diabetes mellitus (T2DM) and acute coronary syndrome and to evaluate the safety and efficacy and its impact on hospitalization and short-term glycemic variability (GV). Methods A 12-week, open-label, prospective, randomized pilot clinical study with parallel groups that compared liraglutide (group 1) with glargine (group 2) and its impact on glycemic control and GV. Results Thirteen patients were included. During hospitalization, mean glucose was 164.75 mg/dL (standard deviation [SD] 19.94) in group 1 and 166.69 mg/dL (38.22) in group 2. GV determined by CV and SD was 20.98 (7.68) vs. 25.48 (7.19) and 34.37 (13.05) vs. 43.56 (19.53) in groups 1 and 2, respectively. Group 1 prandial insulin requirements during hospitalization were lower compared with group 2. Follow-up A1c in group 1 was 6.9% (−1.51%) and 6.5% in group 2 (−1.27). GV after discharge and hypoglycemia were lower in group 1 compared with group 2. Conclusions Liraglutide seems to reduce GV in the acute phase of acute coronary syndrome, and patients achieved optimal control with a low incidence of hypoglycemia. These results support the need to explore liraglutide in a larger multicenter trial. Trial registration: The study was approved by the National Medical Ethics Committee of Spain. The study was registered at European Clinical Trials Database (EudraCT): 2014003298-40.

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“…Although hemoglobin A1c (HbA1C) does provide a measure of glycemic control over a period of months and might also be predictive for outcomes in surgical patients, 4 it is also of limited utility in patients with anemia and liver and renal disease, or in patients who have recently received a blood transfusion. 5 Conversely, random glucose levels are easier to obtain with point-of-care devices, and may provide insight into acute variability that likely reflects neurohormonal changes associated with significant endothelial dysfunction and oxidative stress. 5 For example, the GlucoVISION study found that random glucose values greater than 6.86 mmolÁL -1 in patients without diabetes, or more than 7.92 mmolÁL -1 in patients with diabetes, predicted major postoperative cardiovascular events.…”

Section: To the Editormentioning

confidence: 99%

“…5 Conversely, random glucose levels are easier to obtain with point-of-care devices, and may provide insight into acute variability that likely reflects neurohormonal changes associated with significant endothelial dysfunction and oxidative stress. 5 For example, the GlucoVISION study found that random glucose values greater than 6.86 mmolÁL -1 in patients without diabetes, or more than 7.92 mmolÁL -1 in patients with diabetes, predicted major postoperative cardiovascular events. 5 Perhaps the best measure of perioperative glycemic control is to consider random glucose values in the context of HbA1c.…”

Section: To the Editormentioning

confidence: 99%

“…5 For example, the GlucoVISION study found that random glucose values greater than 6.86 mmolÁL -1 in patients without diabetes, or more than 7.92 mmolÁL -1 in patients with diabetes, predicted major postoperative cardiovascular events. 5 Perhaps the best measure of perioperative glycemic control is to consider random glucose values in the context of HbA1c.…”

Section: To the Editormentioning

confidence: 99%

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In reply: Regarding the survey on perioperative diabetes medications and glucose control

Brown

Siddiqui

Paul

2019

Can J Anesth/J Can Anesth

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Association of preoperative glucose concentration with myocardial injury and death after non-cardiac surgery (GlucoVISION): a prospective cohort study

Abstract: Full funding sources listed at the end of the paper (see Acknowledgments).

Cited by 29 publications

References 31 publications

<p>The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery</p>

<p>The Effects of Type 2 Diabetes and Postoperative Pneumonia on the Mortality in Inpatients with Surgery</p>

Glycemic variability in type 2 diabetes mellitus and acute coronary syndrome: liraglutide compared with insulin glargine: a pilot study

In reply: Regarding the survey on perioperative diabetes medications and glucose control

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