196-OR: Digital Insulin Therapy Protocol in the Postoperative Period of Coronary Artery Bypass Graft Surgery: A Prospective Randomized Study

Abstract

Introduction: Adequate glycemic control with intravenous insulin therapy in the postoperative period of coronary artery bypass grafting (CABG) in an intensive care unit (ICU) reduces unfavorable clinical outcomes, such as mortality, acute kidney injury (AKI), arrhythmias and nosocomial infection. After discharge from ICU, even still hospitalized, adherence to consensus on inpatient insulin therapy is low, and about 50% of patients do not receive adequate subcutaneous insulin therapy in the ward, consequently in-hospital hyperglycemia (IH) is frequent. Medical apps are increasingly facilitating the medical routine. InsulinAPP is a digital protocol for inpatient glycemic management and already validated. A 16% reduction in blood glucose (BG) has been demonstrated in clinical patients with this protocol. Method: Prospective randomized trial was performed on diabetic patients in CABG postoperative period, after discharge from ICU. The groups were randomized according to the glycemic control protocol: InsulinAPP group (APP) or protocol defined by the assistant team (ST - standard group). The aim is to compare the groups regarding the composite outcome of AKI, nosocomial infection and atrial fibrillation. Results: A total of 41 patients were evaluated (15 in APP and 26 in ST). There was no difference between APP vs. ST group in age (65.1±9.8 vs. 65.1±9.8 years), female gender (40 vs. 46%), body mass index (28.5±4.9 vs. 27.3±5.1 Kg/m2) and estimated glomerular function (68.0±24.1 vs. 69.1±24.5 mL/min, respectively). APP had better BG than ST group (162±28.6 mg/dL vs. 183±34.4 mg/dL, respectively; p = 0.036). Besides, in APP there was a significant reduction of the composite outcome (27% vs. 77%, p=0.002), infection (20% vs. 61%, p Conclusion: The InsulinAPP protocol was more effective in glycemic control and in reducing unfavorable outcomes in the postoperative period of cardiac surgery after discharge from the ICU. Disclosure A. B. Camara de souza: None. M. T. Toyoshima: None.