PMID- 33721199
OWN - NLM
STAT- MEDLINE
DCOM- 20210622
LR  - 20210731
IS  - 1496-8975 (Electronic)
IS  - 0832-610X (Linking)
VI  - 68
IP  - 7
DP  - 2021 Jul
TI  - Intranasal administration of 40 and 80 units of insulin does not cause 
      hypoglycemia during cardiac surgery: a randomized controlled trial.
PG  - 991-999
LID - 10.1007/s12630-021-01969-5 [doi]
AB  - PURPOSE: Intranasal insulin administration may improve cognitive function in 
      patients with dementia and may prevent cognitive problems after surgery. Although 
      the metabolic effects of intranasal insulin in non-surgical patients have 
      been studied, its influence on glucose concentration during surgery is unknown. 
      METHODS: We conducted a randomized, double-blind, placebo-contolled trial in 
      patients scheduled for elective cardiac surgery. Patients with type 2 diabetes 
      mellitus (T2DM) and non-T2DM patients were randomly allocated to one of three 
      groups (normal saline, 40 international units [IU] of intranasal insulin, and 80 
      IU intranasal insulin). Insulin was given after the induction of general 
      anesthesia. Glucose and plasma insulin concentrations were measured in ten-minute 
      intervals during the first hour and every 30 min thereafter. The primary outcome 
      was the change in glucose concentration 30 min after intranasal 
      insulin administration. RESULTS: A total of 115 patients were studied, 43 of whom 
      had T2DM. In non-T2DM patients, 40 IU intranasal insulin did not affect glucose 
      concentration, while 80 IU intranasal insulin led to a statistically significant 
      but not clinically important decrease in blood glucose levels (mean difference, 
      0.4 mMol.L(-1); 95% confidence interval, 0.1 to 0.7). In T2DM patients, neither 
      40 IU nor 80 IU of insulin affected glucose concentration. No hypoglycemia (< 4.0 
      mMol.L(-1)) was observed after intranasal insulin administration in any patients. 
      In non-T2DM patients, changes in plasma insulin were similar in the three groups. 
      In T2DM patients, there was an increase in plasma insulin concentrations ten 
      minutes after administration of 80 IU of intranasal insulin compared with saline. 
      CONCLUSIONS: In patients with and without T2DM undergoing elective cardiac 
      surgery, intranasal insulin administration at doses as high as 80 IU did not 
      cause clinically important hypoglycemia. TRIAL REGISTRATION: 
      www.ClinicalTrials.gov (NCT02729064); registered 5 April 2016.
FAU - Roque, Patricia
AU  - Roque P
AD  - School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Montreal, QC, 
      Canada.
FAU - Nakadate, Yosuke
AU  - Nakadate Y
AUID- ORCID: 0000-0002-5095-2072
AD  - Department of Anesthesiology, University of Yamanashi, 1110 Shimokato, Chuo, 
      Yamanashi, 409-3898, Japan. ynakadate@yamanashi.ac.jp.
FAU - Sato, Hiroaki
AU  - Sato H
AD  - Department of Anesthesia, McGill University Health Centre Glen Site, Royal 
      Victoria Hospital, Montreal, QC, Canada.
FAU - Sato, Tamaki
AU  - Sato T
AD  - Department of Anesthesia, McGill University Health Centre Glen Site, Royal 
      Victoria Hospital, Montreal, QC, Canada.
FAU - Wykes, Linda
AU  - Wykes L
AD  - School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, Montreal, QC, 
      Canada.
FAU - Kawakami, Akiko
AU  - Kawakami A
AD  - Department of Anesthesia, McGill University Health Centre Glen Site, Royal 
      Victoria Hospital, Montreal, QC, Canada.
FAU - Yokomichi, Hiroshi
AU  - Yokomichi H
AD  - Department of Health science, University of Yamanashi, Shimokato, Chuo, 
      Yamanashi, Japan.
FAU - Matsukawa, Takashi
AU  - Matsukawa T
AD  - Department of Health science, University of Yamanashi, Shimokato, Chuo, 
      Yamanashi, Japan.
FAU - Schricker, Thomas
AU  - Schricker T
AD  - Department of Anesthesia, McGill University Health Centre Glen Site, Royal 
      Victoria Hospital, Montreal, QC, Canada.
LA  - eng
SI  - ClinicalTrials.gov/NCT02729064
PT  - Journal Article
PT  - Randomized Controlled Trial
TT  - L'administration intranasale de 40 et 80 unites d'insuline ne provoque pas 
      d'hypoglycemie pendant une chirurgie cardiaque : une etude randomisee controlee.
DEP - 20210315
PL  - United States
TA  - Can J Anaesth
JT  - Canadian journal of anaesthesia = Journal canadien d'anesthesie
JID - 8701709
RN  - 0 (Blood Glucose)
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - Administration, Intranasal
MH  - Blood Glucose
MH  - *Cardiac Surgical Procedures
MH  - *Diabetes Mellitus, Type 2/drug therapy
MH  - Double-Blind Method
MH  - Humans
MH  - *Hypoglycemia/chemically induced/prevention & control
MH  - Hypoglycemic Agents
MH  - Insulin/therapeutic use
OTO - NOTNLM
OT  - cardiac surgery
OT  - delirium
OT  - glycemia
OT  - intranasal insulin
EDAT- 2021/03/16 06:00
MHDA- 2021/06/23 06:00
CRDT- 2021/03/15 17:37
PHST- 2020/08/06 00:00 [received]
PHST- 2021/01/02 00:00 [accepted]
PHST- 2020/12/30 00:00 [revised]
PHST- 2021/03/16 06:00 [pubmed]
PHST- 2021/06/23 06:00 [medline]
PHST- 2021/03/15 17:37 [entrez]
AID - 10.1007/s12630-021-01969-5 [pii]
AID - 10.1007/s12630-021-01969-5 [doi]
PST - ppublish
SO  - Can J Anaesth. 2021 Jul;68(7):991-999. doi: 10.1007/s12630-021-01969-5. Epub 2021 
      Mar 15.