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The influence of pre-admission hypoglycaemic therapy on cardiac morbidity and mortality in type 2 diabetic patients undergoing major non-cardiac surgery: a prospective observational study*
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
ID
1196850
Author(s)
Bolliger, D; Seeberger, M D; Lurati Buse, G; Christen, P; Seeberger, E; Ruppen, W; Filipovic, M
The influence of pre-admission hypoglycaemic therapy on cardiac morbidity and mortality in type 2 diabetic patients undergoing major non-cardiac surgery: a prospective observational study*
Journal
Anaesthesia
Volume
67
Number
2
Pages / Article-Number
149-57
Abstract
It remains unclear whether type 2 diabetics treated with either insulin or oral hypoglycaemic agents have the same incidence of cardiac morbidity and mortality after major non-cardiac surgery. We prospectively studied 360 type 2 diabetic patients undergoing major non-cardiac surgery of which 105 were treated with insulin only, 171 were treated with oral hypoglycaemics only and 84 were treated with a combination of insulin and oral hypoglycaemics. All-cause mortality after 30?days and after 12?months was highest in the insulin (10% and 26%) and lowest in the oral hypoglycaemics group (2% and 13%; p = 0.02 and 0.007, respectively). Insulin treatment was independently associated with increased mortality after 30?days (hazard ratio 3.93; 95% CI 1.22-12.64; p?=?0.022) and 12?months (hazard ratio 2.03; 95% CI 1.16-3.58; p?=?0.014) after multivariate adjustment for age, sex and the revised cardiac risk index (insulin treatment excluded). The increased mortality in insulin-treated diabetic patients may be due to a more progressive disease state in these patients rather than the treatment modality itself.
