Improving Neurologic Outcomes in People With Diabetes Who Are Undergoing Heart Surgery
Improving Neurologic Outcomes in Diabetics Undergoing Cardiac Surgery
調査の概要
詳細な説明
People with diabetes who undergo heart surgery have a greater risk of experiencing a stroke and developing cognitive functioning problems than people without diabetes who undergo heart surgery. There may be a connection between disturbances in glucose metabolism, endothelial dysfunction, and poor neurological outcomes after heart surgery. People with diabetes who receive more intensive blood glucose management during and after heart surgery may have better neurological outcomes than people who control their blood glucose levels in a standard way. The purpose of this study is to evaluate the effectiveness of using a traditional method of controlling blood glucose levels versus a tailored, more intensive method of glucose control on neurological outcomes in people with diabetes who are undergoing heart surgery. Researchers will also examine genetic factors that may be associated with insulin resistance and inflammation.
This study will enroll people undergoing heart surgery. On the day before surgery, participants will undergo a blood collection and neuropsychological testing. They will then be randomly assigned to either a traditional method of blood glucose control or an intensive, tailored method of blood glucose control. Participants following the traditional method of blood glucose control may receive insulin several times a day, based on the results of glucose monitoring. Participants following the intensive, tailored method of blood glucose control will undergo hourly measurements of their glucose levels and receive insulin adjustments as needed to maintain a glucose level of 100-140 mg/dL. During surgery, all participants will undergo an ultrasound of their neck to monitor blood vessel activity. Additional blood samples will be collected during surgery, 6 hours after surgery, 24 hours after surgery, and upon hospital discharge or 5 days after surgery.
One week after surgery or just before leaving the hospital, participants will undergo a magnetic resonance imaging (MRI) procedure and neuropsychological testing. Before leaving the hospital, participants will take part in a diabetes education session and nutrition counseling. Three to 6 weeks and 6 months after surgery, participants will undergo repeat neuropsychological testing. Once a month for 6 months, participants who received the intensive, tailored method of blood glucose control will attend study visits at which time study researchers will monitor their diabetes.
研究の種類
入学 (実際)
段階
- フェーズ 3
連絡先と場所
研究場所
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North Carolina
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Winston-Salem、North Carolina、アメリカ、27057
- Wake Forest Baptist Medical Center
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参加基準
適格基準
就学可能な年齢
健康ボランティアの受け入れ
受講資格のある性別
説明
Inclusion Criteria:
- History of diabetes, elevated fasting blood glucose, elevated hemoglobin A1c, or elevation of these variables during the current hospital admission
- Scheduled to undergo coronary artery bypass graft (CABG) surgery
- Scheduled to undergo aortic valve replacement (AVR), mitral valve replacement (MVR), or both
- Scheduled to undergo valve replacement with CABG
Exclusion Criteria:
- Undergoing emergent (i.e., urgent) procedures
- Alzheimer's disease or similar dementias
- Severe claustrophobia
- Kidney insufficiency, as defined by serum creatine levels greater than 2.0 mg/dL
- Cannot be expected to complete neuropsychological testing
- Recent extensive, life threatening acute myocardial infarction (AMI)
研究計画
研究はどのように設計されていますか?
デザインの詳細
- 主な目的:処理
- 割り当て:ランダム化
- 介入モデル:並列代入
- マスキング:なし(オープンラベル)
武器と介入
参加者グループ / アーム |
介入・治療 |
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実験的:Intensive Glucose Management
Participants will receive intensive glucose management.
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Participants in the intensive glucose management group will undergo strict management of their blood glucose levels with a target whole blood glucose level of 100-140 mg/dL preoperatively, intraoperatively, and postoperatively in the intensive care unit (ICU).
Once meals are started, targets for glycemia management will be (a) fasting: 80-140 mg/dL, (b) postprandial: 140-180 mg/dL.
Prior to hospital discharge, participants will receive an in-depth diabetes education session.
After hospital discharge, participants will attend monthly study visits for 6 months so that study researchers can monitor their glycemia management.
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アクティブコンパレータ:Traditional Glucose Management
Participants will receive a traditional method of glucose management.
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Participants will receive traditional management of blood glucose levels while in the hospital.
They may receive insulin several times a day, based on the results of glucose monitoring.
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この研究は何を測定していますか?
主要な結果の測定
結果測定 |
時間枠 |
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Proportion of participants with identifiable brain lesions detected by magnetic resonance imaging (MRI)
時間枠:Measured 1 week after surgery
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Measured 1 week after surgery
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Proportion of participants with new neuropsychological deficits (20% decline on two or more neuropsychological tests)
時間枠:Measured 6 months after surgery
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Measured 6 months after surgery
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二次結果の測定
結果測定 |
時間枠 |
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Number of lesions, as measured by MRI
時間枠:Measured 1 week after surgery
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Measured 1 week after surgery
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Size of lesions, as measured by MRI
時間枠:Measured 1 week after surgery
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Measured 1 week after surgery
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Genetic analysis (i.e., predictive utility of haplotype assignment on primary outcomes)
時間枠:Measured 6 months after surgery
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Measured 6 months after surgery
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Neuropsychological deficits (i.e., predictive utility of neuropsychological performance on presence, number, and volume of lesions)
時間枠:Measured 6 months after surgery
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Measured 6 months after surgery
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協力者と研究者
捜査官
- 主任研究者:Edward H. Kincaid, MD、Wake Forest University Health Sciences
- スタディディレクター:Jorge Calles-Escandon, MD、Wake Forest University Health Sciences
- スタディディレクター:Donald W. Bowden, PhD、Wake Forest University Health Sciences
- スタディディレクター:David A. Stump, PhD、Wake Forest University Health Sciences
研究記録日
主要日程の研究
研究開始
一次修了 (実際)
研究の完了 (実際)
試験登録日
最初に提出
QC基準を満たした最初の提出物
最初の投稿 (見積もり)
学習記録の更新
投稿された最後の更新 (見積もり)
QC基準を満たした最後の更新が送信されました
最終確認日
詳しくは
この情報は、Web サイト clinicaltrials.gov から変更なしで直接取得したものです。研究の詳細を変更、削除、または更新するリクエストがある場合は、register@clinicaltrials.gov。 までご連絡ください。 clinicaltrials.gov に変更が加えられるとすぐに、ウェブサイトでも自動的に更新されます。
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