We found a match
Your institution may have access to this item. Find your institution then sign in to continue.
- Title
Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial.
- Authors
Umpierrez, Guillermo; Cardona, Saumeth; Pasquel, Francisco; Jacobs, Sol; Limin Peng; Unigwe, Michael; Newton, Christopher A.; Smiley-Byrd, Dawn; Vellanki, Priyathama; Halkos, Michael; Puskas, John D.; Guyton, Robert A.; Thourani, Vinod H.
- Abstract
OBJECTIVE The optimal level of glycemic control needed to improve outcomes in cardiac surgery patients remains controversial. RESEARCH DESIGN AND METHODS 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. RESULTS 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). CONCLUSIONS Intensive insulin therapy to target glucose of 100 and 140mg/dL in the ICU did not significantly reduce perioperative complications compared with target glucose of 141 and 180mg/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.
- Subjects
HYPERGLYCEMIA treatment; INSULIN therapy; CORONARY artery bypass; PEOPLE with diabetes; PERIOPERATIVE care; SURGICAL complications; INTENSIVE care patients; HYPOGLYCEMIA; PATIENTS
- Publication
Diabetes Care, 2015, Vol 38, Issue 9, p1665
- ISSN
0149-5992
- Publication type
Article
- DOI
10.2337/dc15-0303