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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 *
Author(s) -
Bolliger D.,
Seeberger M. D.,
Lurati Buse G.,
Christen P.,
Seeberger E.,
Ruppen W.,
Filipovic M.
Publication year - 2012
Publication title -
anaesthesia
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.839
H-Index - 117
eISSN - 1365-2044
pISSN - 0003-2409
DOI - 10.1111/j.1365-2044.2011.06963.x
Subject(s) - medicine , insulin , hazard ratio , prospective cohort study , diabetes mellitus , type 2 diabetes , surgery , incidence (geometry) , endocrinology , confidence interval , physics , optics
Summary 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.