Abstract
Purpose
The purpose of this study was to compare two perioperative insulin therapies [thrice-daily injections of insulin Lispro Mix 50/50 (3X-Mix50) versus basal-bolus injections (BBT)] in type 2 diabetic patients who were judged by attending endocrinologists to require intensive insulin treatment before surgery.
Materials and methods
A retrospective analysis was performed on data collected from 47 surgical patients hospitalized at Obihiro-Kosei General Hospital and treated with BBT (n = 27) or 3X-Mix50 (n = 20) for 1 year.
Results
Patient baseline characteristics (age, duration of diabetes, BMI, FPG and HbA1c) were similar between therapeutic groups. Both therapies achieved target glycemic control for surgery in 9 days on average. There was no significant difference in average pre-meal or bedtime blood glucose levels. The total daily insulin dose before surgery was similar (28.3 U in BBT vs. 24.8 U in 3X-Mix50, p = 0.1146). No episodes of severe hypoglycemia occurred, and the number of episodes of mild hypoglycemia during the perioperative period was similar. No surgical complications such as infection occurred, and one orthopedic surgery-related issue occurred in each therapeutic group.
Conclusion
We showed 3X-Mix50 and BBT were comparable in terms of glycemic control, total insulin dose, and incidence of hypoglycemia and perioperative complications. While comparable to classical BBT therapy, the 3X-Mix50 provides a convenient alternative method for maintaining glycemic control in patients with type 2 diabetes during the perioperative period.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Doenst T, Wijeysundera D, Karkouti K, Zechner C, Maganti M, Rao V, et al. Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery. J Thorac Cardiovasc Surg. 2005;130:1144.
Estrada CA, Young JA, Nifong LW, Chitwood WR Jr. Outcomes and perioperative hyperglycemia in patients with or without diabetes mellitus undergoing coronary artery bypass grafting. Ann Thorac Surg. 2003;75:1392–9.
Marhoffer W, Stein M, Maeser E, Federlin K. Impairment of polymorphonuclear leukocyte function and metabolic control of diabetes. Diabetes Care. 1992;15:256–60.
Turina M, Fry DE, Polk HC Jr. Acute hyperglycemia and the innate immune system: clinical, cellular, and molecular aspects. Crit Care Med. 2005;33:1624–33.
Bower WF, Lee PY, Kong AP, Jiang JY, Underwood MJ, Chan JC, et al. Peri-operative hyperglycemia: a consideration for general surgery? Am J Surg. 2010;199:240–8.
Okabayashi T, Ichikawa K, Namikawa T, Sugimoto T, Kobayashi M, Hanazaki K. Effect of perioperative intensive insulin therapy for liver dysfunction after hepatic resection. World J Surg. 2011;35:2773–8.
Rosenstock J, Ahmann AJ, Colon G, Scism-Bacon J, Jiang H, Martin S. Advancing insulin therapy in type 2 diabetes previously treated with glargine plus oral agents: prandial premixed (insulin lispro protamine suspension/lispro) versus basal/bolus (glargine/lispro) therapy. Diabetes Care. 2008;31:20–5.
Polonsky WH, Anderson BJ, Lohrer PA, Welch G, Jacobson AM, Aponte JE, et al. Assessment of diabetes-related distress. Diabetes Care. 1995;18:754–60.
Zinman B, Tildesley H, Chiasson JL, Tsui E, Strack T. Insulin lispro in CSII: results of a double-blind crossover study. Diabetes. 1997;46:440–3.
Yokoyama H, Tada J, Kamikawa F, Kanno S, Yokota Y, Kuramitsu M. Efficacy of conversion from bedtime NPH insulin to morning insulin glargine in type 2 diabetic patients on basal-prandial insulin therapy. Diabetes Res Clin Pract. 2006;73:35–40.
Holman RR, Farmer AJ, Davies MJ, Levy JC, Darbyshire JL, Keenan JF, et al. Three-year efficacy of complex insulin regimens in type 2 diabetes. N Engl J Med. 2009;361:1736–47.
Schernthaner G, Kopp HP, Ristic S, Muzyka B, Peter L, Mitteregger G. Metabolic control in patients with type 2 diabetes using Humalog Mix50 injected three times daily: crossover comparison with human insulin 30/70. Horm Metab Res. 2004;36:188–93.
Matthews DR, Cull CA, Stratton IM, Holman RR, Turner RC. UKPDS 26: Sulphonylurea failure in non-insulin-dependent diabetic patients over six years. UK Prospective Diabetes Study (UKPDS) Group. Diabet Med. 1998;15:297–303.
Gastaldelli A, Ferrannini E, Miyazaki Y, Matsuda M, DeFronzo RA. Beta-cell dysfunction and glucose intolerance: results from the San Antonio metabolism (SAM) study. Diabetologia. 2004;47:31–9.
Acknowledgments
This work was supported by grants from the Japanese Ministry of Education, Culture, Sports, Science, and Technology Foundation no. 22590990 and Suzuki Kenzo Memorial Foundation (HM). HM thanks Dr. James W. Perfield II (University of Missouri, MO, USA) for his continued support and mentorship.
Author information
Authors and Affiliations
Corresponding author
Additional information
K. Y. Cho and O. Nakagaki contributed equally to this paper.
About this article
Cite this article
Cho, K.Y., Nakagaki, O., Miyoshi, H. et al. Evaluation of thrice-daily injections of insulin Lispro Mix 50/50 versus basal-bolus therapy in perioperative patients with type 2 diabetes. Diabetol Int 5, 117–121 (2014). https://doi.org/10.1007/s13340-013-0140-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13340-013-0140-0