Review
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World J Cardiol. Nov 26, 2014; 6(11): 1209-1217
Published online Nov 26, 2014. doi: 10.4330/wjc.v6.i11.1209
Blood glucose management in the patient undergoing cardiac surgery: A review
Pingle Reddy, Brian Duggar, John Butterworth
Pingle Reddy, Brian Duggar, John Butterworth, Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA 232298-0695, United States
Author contributions: All authors conceived of the project, wrote and edited the manuscript, and are responsible for the content.
Correspondence to: John Butterworth, IV, MD, Professor and Chair of Anesthesiology, Department of Anesthesiology, Virginia Commonwealth University, PO Box 980695, Richmond, VA 232298-0695, United States. jbutterworth@mcvh-vcu.edu
Telephone: +1-804-8289160 Fax: +1-804-8288300
Received: December 28, 2013
Revised: August 27, 2014
Accepted: September 16, 2014
Published online: November 26, 2014
Processing time: 338 Days and 13.7 Hours
Abstract

Both diabetes mellitus and hyperglycemia per se are associated with negative outcomes after cardiac surgery. In this article, we review these associations, the possible mechanisms that lead to adverse outcomes, and the epidemiology of diabetes focusing on those patients requiring cardiac surgery. We also examine outpatient and perioperative management of diabetes with the same focus. Finally, we discuss our own efforts to improve glycemic management of patients undergoing cardiac surgery at our institution, including keys to success, results of implementation, and patient safety concerns.

Keywords: Blood glucose management; Glycemic management; Cardiac surgery; Cardiothoracic surgery; Diabetes; Diabetes mellitus; Hyperglycemia; Perioperative

Core tip: There is a growing body of evidence that moderate glycemic control (e.g., 120-180 mg/dL, 6.7-10.0 mmol/L) is an appropriate goal in cardiac surgery. Achieving this goal can be accomplished by adopting a multidisciplinary approach, addressing the entire continuum of care, demanding a short project timeline, and identifying gaps in current management.