Perioperative glycemic control in patients who underwent cardiac transplantation and effect on the outcome at discharge in a tertiary care centre

• Main Authors: Lohit Kumbar, Sandeep Donagaon, U M Nagamalesh, Ravi Shankar Shetty, Pramila Kalra
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2020-01-01
• Series: Indian Journal of Endocrinology and Metabolism
• Subjects: cardiac transplantation; diabetes mellitus; insulin; perioperative
• Online Access: http://www.ijem.in/article.asp?issn=2230-8210;year=2020;volume=24;issue=3;spage=270;epage=274;aulast=Kumbar

Objectives: To study the glycemic status and insulin requirements in patients who underwent cardiac transplantation and to compare it among patients with and without diabetes mellitus. To compare preoperative glycemic status and perioperative insulin requirements with the outcome. Methods and Materials: The retrospective data of the glycemic status of patients before and after cardiac transplantation were collected and analyzed. Different variables like HbA1c, creatinine, age, BMI, and glycemic status were compared with the outcome. Results: A total of 18 patients with a mean age of 46.72 ± 16.94 years (mean ± SD) and a median age of 48.5 years underwent cardiac transplantation. The mean preoperative glycosylated hemoglobin (HbA1c) was 8.75 ± 2.15% (72 ± 2.36 mmol/mol) and 5.82 ± 0.45% (40 ± 4.89 mmol/mol) in patients with and without diabetes mellitus, respectively. The mean insulin requirement of insulin on postoperative days 0, 1, 2, and 3 was 1.396, 0.503, 0.490, and 0.537 (IU/kg/day) in patients with diabetes, whereas in patients without diabetes mellitus it was 1.955, 0.561, 1.19, and 0.61 (IU/kg/day), respectively. The mean insulin requirement at the time of discharge was 0.698 ± 0.43 IU/kg/day (mean ± SD) and 1.285 ± 1 IU/kg/day (mean ± SD) (p = 0.36) in patients with and without diabetes mellitus, respectively (p = 0.53, 0.11, 0.41, and 0.32, respectively). There was no association with the outcome when analyzed with different variables like HbA1c, creatinine, BMI, age, hemoglobin, insulin requirements, and glycemic status. Conclusions: Perioperative glycemic control is crucial for successful cardiac transplantation irrespective of diabetic status.