Use of an insulin titration protocol based on continuous glucose monitoring in postoperative cardiac surgery patients with type 2 diabetes and prediabetes: a randomized controlled trial.

IF 8.5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Cardiovascular Diabetology Pub Date : 2025-05-14 DOI:10.1186/s12933-025-02747-z

Sun-Joon Moon, Min-Su Kim, Yun Tae Kim, Ha-Eun Lee, Young-Woo Lee, Su-Ji Lee, Euy-Suk Chung, Cheol-Young Park

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引用次数: 0

Abstract

Background: Maintaining optimal glucose control is critical for postoperative care cardiac surgery patients. Continuous glucose monitoring (CGM) in this setting remains understudied. We evaluated the efficacy of CGM with a specialized titration protocol in cardiac surgery patients with type 2 diabetes (T2D) and prediabetes.

Methods: In this randomized-controlled trial, 54 cardiac surgery patients were randomized one day post-surgery, with 27 CGM and 25 point-of-care (POC) patients completing the study. The CGM group used Dexcom G6 with a CGM-specialized titration protocol, while the POC group used standard monitoring with blinded CGM. The primary outcome was time-in-range (TIR) 100-180 mg/dL for 7 days post-surgery. Secondary outcomes included various glycemic metrics and surgical outcomes. Multiple comparison adjustments were performed using false-discovery-rate (FDR).

Results: Thirty-one (59.6%) had diabetes and 21 (40.4%) had prediabetes. While TIR 100-180 mg/dL showed no difference (74.7% vs. 71.6%, FDR-adjusted p = 0.376), the CGM group demonstrated improvements in TIR 70-180 mg/dL (83.8% vs. 75.8%, FDR-adjusted p = 0.026), time-in-tight-range (TITR) 100-140 mg/dL (46.3% vs. 36.3%, FDR-adjusted p = 0.018), and TITR 70-140 mg/dL (55.3% vs. 40.5%, FDR-adjusted p = 0.003). Both groups maintained very low rates of time below range (< 70 mg/dL: 0.03% vs. 0.18%, FDR-adjusted p = 0.109). The CGM group showed lower postoperative atrial fibrillation (AF) (18.8% vs. 55.6%, FDR-adjusted p = 0.04999).

Conclusion: While the primary outcome was not achieved, CGM with a specialized titration protocol demonstrated safe glycemic control with improvements in TIR 70-180 mg/dL and TITRs in cardiac surgery patients with T2D and prediabetes. The observed reduction in postoperative AF warrants further investigation.

Trial registration: ClinicalTrials.gov NCT06275971.

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基于持续血糖监测的2型糖尿病和前驱糖尿病患者心脏手术后胰岛素滴定方案的使用：一项随机对照试验

背景：维持最佳血糖控制对心脏手术患者的术后护理至关重要。在这种情况下，持续血糖监测（CGM）仍有待进一步研究。我们用专门的滴定方案评估了CGM在心脏手术合并2型糖尿病（T2D）和糖尿病前期患者中的疗效。方法：在这项随机对照试验中，54例心脏手术患者在术后一天随机分组，其中27例CGM患者和25例POC患者完成了研究。CGM组采用Dexcom G6和CGM专用滴定方案，而POC组采用盲法CGM标准监测。主要终点是术后7天的时间范围（TIR） 100-180 mg/dL。次要结果包括各种血糖指标和手术结果。使用假发现率（FDR）进行多次比较调整。结果：糖尿病31例（59.6%），前驱糖尿病21例（40.4%）。虽然TIR 100-180 mg/dL没有差异（74.7% vs. 71.6%， fdr调整p = 0.376），但CGM组在TIR 70-180 mg/dL （83.8% vs. 75.8%， fdr调整p = 0.026）、TIR 100-140 mg/dL （46.3% vs. 36.3%， fdr调整p = 0.018）和TIR 70-140 mg/dL （55.3% vs. 40.5%， fdr调整p = 0.003）方面均有改善。结论：虽然没有达到主要结果，但采用特殊滴定方案的CGM显示出安全的血糖控制，TIR在70-180 mg/dL和心脏手术合并t2dm和前体糖尿病患者的TIR有所改善。观察到的术后房颤减少值得进一步研究。试验注册：ClinicalTrials.gov NCT06275971。

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来源期刊

Cardiovascular Diabetology 医学-内分泌学与代谢

CiteScore

12.30

自引率

15.10%

发文量

240

审稿时长

1 months

期刊介绍： Cardiovascular Diabetology is a journal that welcomes manuscripts exploring various aspects of the relationship between diabetes, cardiovascular health, and the metabolic syndrome. We invite submissions related to clinical studies, genetic investigations, experimental research, pharmacological studies, epidemiological analyses, and molecular biology research in this field.