Perioperative tight glucose control reduces postoperative adverse events in non-diabetic cardiac surgery patients.

Journal of clinical Endocrinology and Metabolism- June 16th 2015.

Context:
Tight glucose control (TGC) reduces morbidity and mortality in patients undergoing elective cardiac surgery, but only limited data about its optimal timing are available to date.

Objective:
To compare the effects of perioperative (PERI) versus postoperative (POST) initiation of TGC on postoperative adverse events in cardiac surgery patients[
Design:
Single center, single-blind, parallel-group, randomized controlled trial.
Settings:
Academic tertiary hospital.

Participants:
2383 hemodynamically stable patients undergoing major cardiac surgery with expected postoperative ICU treatment for at least 2 consecutive days.

Intervention:
Perioperatively or postoperatively initiated intensive insulin therapy with target glucose range 4.4–6.1 mmol/l.

Main Outcome Measures:
Adverse events from any cause during postoperative hospital stay.

Results:
In the whole cohort, perioperatively initiated TGC markedly reduced the number of postoperative complications (23.2 vs. 34.1%, 95% CI 0.60–0.78) in spite of only minimal improvement in glucose control (blood glucose 6.6±0.7 vs. 6.7±0.8 mmol/l, p<0.001; time in target range 39.3±13.7 vs. 37.3±13.8%, p<0.001).

The positive effects of TGC on postoperative complications were driven by non-diabetic subjects (21.3 vs. 33.7%, 95% CI 0.54–0.74; blood glucose 6.5±0.6 vs. 6.6±0.8 mmol/, n.s.; time in target range 40.8±13.6 vs. 39.7±13.8%, n.s.), while no significant effect was seen in diabetic patients

(29.4 vs. 35.1%, 95% CI 0.66–1.06) despite significantly better glucose control in the PERI group (blood glucose 6.9±1.0 vs. 7.1±0.8 mmol/l, p<0.001; time in target range 34.3±12.7 vs. 30.8±11.5%, p<0.001).

Conclusions:
Perioperative initiation of intensive insulin therapy during cardiac surgery reduces postoperative morbidity in non-diabetic patients while having minimal effect in diabetic subjects.

G Mohan.