Nearly half of all heart surgery patients may experience blood sugar levels high enough to require temporary insulin treatment after their operation, even though they've never had diabetes, according to a new study from the University of Michigan Health System.
And a significant minority of those patients might need to take medicines for days or even weeks after they leave the hospital, to help their blood sugar levels reach normal again, the researchers show. Obese patients, older patients, and those whose blood sugar levels were still high two days after their operation are most likely to need this kind of treatment, they find.
Although the study didn't look at whether such patients later developed true diabetes or pre-diabetes, the results are striking enough to warrant a new U-M research project. It will recruit patients before their operations, and will include longer follow-up and more rigorous testing of pre-surgery and post-hospitalization blood sugar levels.
On Sunday at the American Diabetes Association's Scientific Sessions in San Francisco, a U-M team presented their findings in a poster that included retrospective data from 1,362 patients who had certain heart and vascular operations at U-M in 2006 and 2007.
Of them, 662 developed "stress induced hyperglycemia", or high blood sugar after surgery, and 87 needed blood sugar medicines when they left the hospital.
The study was possible because UMHS has a dedicated team of physicians, physician assistants and nurse practitioners called the Hospital Intensive Insulin Program who look for and treat elevated blood sugar in all heart and vascular surgery patients. Led by U-M endocrinologist Roma Gianchandani, M.D., the team gives insulin and oral medicines during these patients' hospital stays, and prescribes medicines for the patients to take at home. They also recommend that such patients receive further blood-sugar testing from their primary care doctors.
But high blood sugar in non-diabetic patients after surgery hasn't been fully studied, says Sima Saberi, M.D., the U-M endocrinology fellow who presented at the ADA meeting.
Stress-induced hyperglycemia occurs when the body reacts to the double insults of having an operation on the heart or major blood vessels, and of being cooled down by the heart-bypass machine to protect the heart muscle during surgery.
Heart and vascular surgeons already know that high blood sugar during surgery itself is associated with worse recovery and a higher risk of infection and death. So, most heart and blood vessel surgery patients currently have their blood sugars monitored while they're in the operating room, and many patients receive doses of insulin while the operation is going on.
The new study looked at what happened after surgery, and what factors predicted a need for blood sugar treatment. By far, the most telling sign that a person was likely to need such treatment -- both in the hospital and as they went home -- was their average blood sugar two days after surgery.
Those patients whose glucose levels were still high at this point were more than two and a half times more likely to need post-hospital medicines, even after other factors were considered.
Patients who had a body mass index (BMI) over 35, which is consistent with a diagnosis of obesity, were also somewhat more likely to develop SIH, as were older patients. But these factors were not nearly as strongly predictive of SIH as was the glucose level on the second day after surgery.
Still, Saberi says, overweight patients who carry their excess weight mainly around their waists, in the form of belly fat, are more likely to have metabolic syndrome, which involves both increased cardiovascular risk and increased risk of diabetes.
The patients in the study had either a coronary artery bypass operation, a heart valve operation, or an operation on the upper part of their aorta, the major blood vessel that leads out of the heart to the rest of the body.
Kara Gavin | EurekAlert!
Satellites, airport visibility readings shed light on troops' exposure to air pollution
09.12.2016 | Veterans Affairs Research Communications
Oxygen can wake up dormant bacteria for antibiotic attacks
08.12.2016 | Penn State
Physicists of the University of Würzburg have made an astonishing discovery in a specific type of topological insulators. The effect is due to the structure of the materials used. The researchers have now published their work in the journal Science.
Topological insulators are currently the hot topic in physics according to the newspaper Neue Zürcher Zeitung. Only a few weeks ago, their importance was...
In recent years, lasers with ultrashort pulses (USP) down to the femtosecond range have become established on an industrial scale. They could advance some applications with the much-lauded “cold ablation” – if that meant they would then achieve more throughput. A new generation of process engineering that will address this issue in particular will be discussed at the “4th UKP Workshop – Ultrafast Laser Technology” in April 2017.
Even back in the 1990s, scientists were comparing materials processing with nanosecond, picosecond and femtosesecond pulses. The result was surprising:...
Have you ever wondered how you see the world? Vision is about photons of light, which are packets of energy, interacting with the atoms or molecules in what...
A multi-institutional research collaboration has created a novel approach for fabricating three-dimensional micro-optics through the shape-defined formation of porous silicon (PSi), with broad impacts in integrated optoelectronics, imaging, and photovoltaics.
Working with colleagues at Stanford and The Dow Chemical Company, researchers at the University of Illinois at Urbana-Champaign fabricated 3-D birefringent...
In experiments with magnetic atoms conducted at extremely low temperatures, scientists have demonstrated a unique phase of matter: The atoms form a new type of quantum liquid or quantum droplet state. These so called quantum droplets may preserve their form in absence of external confinement because of quantum effects. The joint team of experimental physicists from Innsbruck and theoretical physicists from Hannover report on their findings in the journal Physical Review X.
“Our Quantum droplets are in the gas phase but they still drop like a rock,” explains experimental physicist Francesca Ferlaino when talking about the...
16.11.2016 | Event News
01.11.2016 | Event News
14.10.2016 | Event News
09.12.2016 | Life Sciences
09.12.2016 | Ecology, The Environment and Conservation
09.12.2016 | Health and Medicine