Details

Autor(en) / Beteiligte

• Umpierrez, Guillermo
• Cardona, Saumeth
• Pasquel, Francisco
• Jacobs, Sol
• Peng, Limin
• Unigwe, Michael
• Newton, Christopher A
• Smiley-Byrd, Dawn
• Vellanki, Priyathama
• Halkos, Michael
• Puskas, John D
• Guyton, Robert A
• Thourani, Vinod H

Titel

Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial

Ist Teil von

• Diabetes care, 2015-09, Vol.38 (9), p.1665-1672

Ort / Verlag

United States: American Diabetes Association

Erscheinungsjahr

2015

Quelle

MEDLINE

Beschreibungen/Notizen

• The optimal level of glycemic control needed to improve outcomes in cardiac surgery patients remains controversial. We randomized patients with diabetes (n = 152) and without diabetes (n = 150) with hyperglycemia to an intensive glucose target of 100-140 mg/dL (n = 151) or to a conservative target of 141-180 mg/dL (n = 151) after coronary artery bypass surgery (CABG) surgery. After the intensive care unit (ICU), patients received a single treatment regimen in the hospital and 90 days postdischarge. Primary outcome was differences in a composite of complications, including mortality, wound infection, pneumonia, bacteremia, respiratory failure, acute kidney injury, and major cardiovascular events. Mean glucose in the ICU was 132 ± 14 mg/dL (interquartile range [IQR] 124-139) in the intensive and 154 ± 17 mg/dL (IQR 142-164) in the conservative group (P < 0.001). There were no significant differences in the composite of complications between intensive and conservative groups (42 vs. 52%, P = 0.08). We observed heterogeneity in treatment effect according to diabetes status, with no differences in complications among patients with diabetes treated with intensive or conservative regimens (49 vs. 48%, P = 0.87), but a significant lower rate of complications in patients without diabetes treated with intensive compared with conservative treatment regimen (34 vs. 55%, P = 0.008). Intensive insulin therapy to target glucose of 100 and 140 mg/dL in the ICU did not significantly reduce perioperative complications compared with target glucose of 141 and 180 mg/dL after CABG surgery. Subgroup analysis showed a lower number of complications in patients without diabetes, but not in patients with diabetes treated with the intensive regimen. Large prospective randomized studies are needed to confirm these findings.