Glycemic Control during Coronary Artery Bypass Graft Surgery

Table 1

Suggested use of the HA1c during hospitalization for discharge planning for hyperglycemic patients.

	Unknown diabetes	Known diabetes	Followup
HA1c < 6.5%*	Assess diabetes risk factors. Counseling and outpatient screening within 3 months
HA1c 6.5–7%* and insulin requirement < 0.4 units/kg/day	Counseling and outpatient screening within 3 months ± pharmacologic prevention**	Assess for hypoglycemia risk.; Continue prehospital regime unless new safety concerns.	Communicate recommendation to outpatient providers.; Address need for referral to multidisciplinary care for diabetes treatment or prevention
HA1c 6.5–7%* and insulin requirement ≥ 0.4 units/kg/day	Counseling and initiation of appropriate diabetes treatment plan
HA1c > 7%*	Counseling and initiation of appropriate diabetes treatment plan	Consider transient effect of subacute illness (e.g., angina) prior to hospitalization on HA1c. Consider advising augmentation of outpatient regimen to target <7%

Adapted from Supplement to ACP Hospitalist. December 15, 2009. *Note, the A1c is inaccurate after blood transfusion and in severe anemia, or in high or low red blood cell turnover states. **Metformin or acarbose.