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Tight glucose control benefits cardiac surgery patients without diabetes
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Postoperative morbidity in patients without diabetes undergoing cardiac surgery was reduced with perioperative initiation of intensive insulin therapy, according to recent study findings published in The Journal of Clinical Endocrinology & Metabolism.
However, this effect was minimal in patients with diabetes, according to the researchers.
Martin Haluzík, MD, DSc , of General University Hospital in the Czech Republic, and colleagues evaluated 2,383 patients aged 18 to 90 years undergoing cardiac surgery at an academic tertiary hospital between January 2007 and June 2012 to compare the effects of perioperative and postoperative initiation of tight glucose control on adverse events. Participants were randomly assigned to intensive insulin therapy perioperatively (n = 1,134) or postoperatively (n = 1,249). All participants were expected to receive postoperative ICU treatment for at least 2 consecutive days after the surgery. The target glucose range was 4.4 mmol/L to 6.1 mmol/L.
Compared with the postoperative group, the perioperative group was significantly less likely to develop organ complications (RR = 0.68; 95% CI, 0.6-0.78).
Patients without diabetes had even more favorable effects of intraoperatively initiated tight glucose control and achieved a risk reduction of 37% for developing any postoperative complication (RR = 0.63; 95% CI, 0.54-0.74).
No difference was found for postoperative complication incidence for all complications except cardiovascular ones among patients with diabetes in both groups.
“In summary, we have demonstrated that intraoperative initiation of tight glucose control using intensive insulin therapy substantially reduces the incident of postoperative complications without affecting mortality or postoperative [length of stay] in nondiabetic patients undergoing cardiac surgery while having little effect in subjects with [diabetes].” – by Amber Cox
Disclosure: The researchers report no relevant financial disclosures.
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