2025 Southeastern Residency Conference

Title: Evaluation of Blood Glucose Goal of 110-150 mg/dL in Cardiovascular Intensive Care Patients 
Authors: Joy Dahlen, Jessica Odom, Carly Sisk, Benjamin Gustafson, Alex Ewing, Lyndsay Gormley 
Objective: To determine if a target blood glucose range of 110-150 mg/dL after cardiac surgery resulted in a difference in hypoglycemia incidence compared to previous goal ranges
Background: Hyperglycemia is common in patients, with and without diabetes, who have undergone cardiac surgeries such as coronary artery bypass grafting (CABG) and is associated with many adverse outcomes including increased risk of infection, longer hospital length of stay, and increased risk of mortality. Avoiding hyperglycemia after cardiac surgery mitigates these complications.  However, there is controversy over the ideal goal blood glucose range for patients after cardiac surgery. 
Methods: This multi-center, pre- and post-interventional, retrospective cohort study evaluated patients undergoing cardiac surgery utilizing the new Prisma Health cardiac insulin drip with a goal blood glucose of 110-150 mg/dL (moderate) compared to previous goals of 100-140 mg/dL (low) or 120-160 mg/dL (high). Patients were identified based on a surgical report for all cardiac surgeries and then randomized to include a total of 200 patients, divided into four groups of 50 (two pre-intervention and two post-intervention groups from two institutions. Patients were included in the study if aged 18 years or older, underwent cardiac surgery, and received an insulin drip. Patients were excluded from the study if they were placed on extracorporeal membrane oxygenation (ECMO), died in the operating room, or had an open chest post-surgery. The primary outcome was incidence of hypoglycemic events (<70 mg/dL) per 1000 ICU days. Secondary outcomes included: incidence of severe hypo- and hyperglycemic events per 1000 ICU days, incidence of sternal wound infection and positive blood cultures, and 30-day mortality.  
Results: A total of 200 patients were screened for inclusion, and 182 patients were included in the study. The primary outcome of incidence of hypoglycemia <70 mg/dL was significantly lower between pre- and post- intervention group for Site A, increasing the goal from low 100-140 mg/dL to moderate 110-150 mg/dL (317.46 events per 1000 ICU days in the pre-group vs. 138.25 in the post-group, p=0.0006). There was not a significant difference in hypoglycemic events in the pre- and post-intervention groups for Site B, decreasing the goal from high 120-160 mg/dL to moderate 110-150 mg/dL (13.47 events per 1000 ICU days in the pre-group vs. 20 events per 1000 ICU days in the post-group, p=0.56). There were no significant increases in incidence of sternal wound infection, positive blood cultures, or morality from the moderate goal. 
Conclusions: A blood glucose goal of 110-150 mg/dL resulted in significantly lower incidence of hypoglycemic events (<70 mg/dL) compared to a blood glucose goal of 100-140 mg/dL. A blood glucose goal of 110-150 mg/dL did not significantly increase incidence of hypoglycemic events compared to a goal of 120-160 mg/dL. 

Self-assessment question: Which of the following post-operative goal glucose ranges had the highest incidence of hypoglycemia?