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A comparison on the efficacy and safety of different insulin regimens in type 2 diabetes mellitus patients undergoing coronary artery bypass graft surgery in St. Luke's Medical Center.


Cherrie Gail R. Lumapas,
Joselynna Quimpo,
Gabriel Jasul,
Jay Jayme-Wohldorf

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Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Internal Medicine
Six times a year (6x/year)
Publication Date
January-February 2006


OBJECTIVE: This study aims to determine the efficacy and safety of different insulin regimens used in the peri-operative period in diabetics undergoing Coronary Artery Bypass Graft (CABG).

STUDY DESIGN: Analytical Cross-sectional Study

METHODOLOGY: A chart review of Type 2 diabetics who underwent CABG in SLMC from March 2003 to September 2004 was done. The subjects were grouped according to the insulin regimen received during the peri-operative period. The mean blood glucose levels and total insulin infused, frequency of hypoglycemia, duration of CCU stay and post-op complications for each group were compared and analyzed statistically.

RESULTS: 39 patients met the inclusion criteria. 19 were on IV insulin drip alone, 15 on insulin glargine plus insulin drip, and 5 on isophane insulin plus insulin drip. The insulin glargine group had the lowest mean peri-op blood glucose level, lowest post-op insulin drip rate and lowest incidence of hypoglycemia. The isophane insulin group had the lowest insulin infusion rate during the intra-op period. The group on insulin drip alone had the highest peri-op blood glucose levels, insulin infusion rate and complication rate. However, no significant differences were seen among the three groups after statistical analysis.

CONCLUSION: This study suggests that insulin glargine plus intravenous insulin infusion used during CABG resulted in lower blood glucose levels throughout the peri-operative period. Three patients on modified Portland Protocol had lower blood glucose levels than those on the traditional insulin drip sliding scale. However, no significant differences were noted among the groups, because of the limitations in the sample size.

RECOMMENDATIONS: More experience with the use of insulin glargine may further demonstrate its efficacy and safety during the peri-operative period. Thus, we recommend that a head-on comparison between the use of insulin glargine and Portland Protocol during surgery be done in a larger sample size.


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