This article is more than 5 years old. Information may no longer be current.
Intensive glucose management after coronary bypass did not provide additional protection against complications
Click Here to Manage Email Alerts
SAN FRANCISCO — Despite a hypothesis that intensive glucose control after coronary bypass would evade postoperative complications, both intensive and conservative management showed similar results, according to a presenter at the American Diabetes Association’s 74th Scientific Sessions.
Intensive glucose control after bypass resulted in similar measures of ICU or hospital stay, readmissions, ER visits and mortality after discharged when compared with conservative glucose control.
“Our study indicates that intensive glucose control targeting the blood glucose between 100 and 140 in the ICU did not reduce hospital complications ... compared to the target glucose of 141 to 180,” Guillermo E. Umpierrez, MD, of Emory University, Atlanta, said during his presentation. “There was no difference.”
To determine if the 2009 AACE/ADA recommended target glucose levels for ICU patients were on point, Umpierrez and colleagues followed 302 patients (151 in conservative; 151 in intensive glucose control; aged 18-80 years) through intensive care and 90 days after coronary artery bypass graft (CABG) procedure in an open-label randomized controlled trial. The intensive therapy group target was 100-140 mg/dL while the conservative therapy group aimed for 141-180 mg/dL, Umpierrez said.
“I was a member of the committee that wrote these guidelines and we did it with no data. ... This is why we did this study,” Umpierrez said.
Using a computer-guided algorithm (Glucommander, Glytec), the researchers met their goals in IV ICU glucose concentrations, keeping the intensive group at 130±11 mg/dL and the conservative group to 159±14 mg/dL with IV insulin postoperatively and at 132±14 mg/dL and 154±16 mg/dL in the ICU.
In addition, Umpierrez said they achieved a low level of hypoglycemia, which was a “main concern” in previous clinical trials. “The use of computer-guided algorithm resulted in no episodes of severe hypoglycemia.” In looking at other perioperative complications, none showed a significant difference between the two groups, he said.
Nor were there differences in ICU or hospital length or stay, readmissions, emergency room visits or complications and mortality after hospital discharge.
When looking at patients with and without diabetes, those with diabetes did have significantly more death and acute kidney injury, but differences were not significant for adverse events as a whole, wound infection, pneumonia, respiratory failure or major adverse cardiac events.
“In this trial, intensive glucose control did not reduce perioperative complications,” Umpierrez said. “To me, the most important finding is that the lower end is not better than the upper end. If you can do it safely, you can go to 100 to 140, but, if not 140 to 180 should be the preferred target for most people. ... In practice, we should aim for best glucose control if we can avoid hypoglycemia.” — by Katrina Altersitz
For More Information: Umpierrez GE. Abstract 5-OR. Presented at: American Diabetes Association’s 74th Scientific Sessions; June 13-17, 2014; San Francisco.
Disclosures: Umpierrez reports financial relationships with Boehringer Ingelheim Pharmaceuticals, Merck, Novo Nordisk and Sanofi.