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Effects of Aggressive Versus Moderate Glycemic Control on Clinical Outcomes in Diabetic Coronary Artery Bypass Graft Patients

Lazar, Harold L. MD*; McDonnell, Marie M. MD; Chipkin, Stuart MD§; Fitzgerald, Carmel NP*; Bliss, Caleb MA; Cabral, Howard PhD

doi: 10.1097/SLA.0b013e31822c5d78
Papers of the 131st ASA Annual Meeting

Objective: This study sought to determine whether aggressive glycemic control (90–120 mg/dL) would result in more optimal clinical outcomes and less morbidity than moderate glycemic control (120–180 mg/dL) in diabetic patients undergoing coronary artery bypass graft (CABG) surgery.

Summary of Background Data: Maintaining serum glucose levels between 120 and 180 mg/dL with continuous insulin infusions decreases morbidity in diabetic patients undergoing CABG surgery. Studies in surgical patients requiring prolonged ventilation suggest that aggressive glycemic control (<120 mg/dL) may improve survival; however, its effect in diabetic CABG patients is unknown.

Methods: Eighty-two diabetic patients undergoing CABG were prospectively randomized to aggressive glycemic control (90–120 mg/dL) or moderate glycemic control (120–180 mg/dL) using continuous intravenous insulin solutions (100 units regular insulin in 100 mL: normal saline) beginning at the induction of anesthesia and continuing for 18 hours after CABG. Primary end points were the incidence of major adverse events (major adverse events = 30-day mortality, myocardial infarction, neurologic events, deep sternal infections, and atrial fibrillation), the level of serum glucose, and the incidence of hypoglycemic events.

Results: There were no differences in the incidence of major adverse events between the groups (17 moderate vs 15 aggressive; P = 0.91). Patients with aggressive control had a lower mean glucose at the end of 18 hours of insulin infusion (135 ± 12 mg/dL moderate vs 103 ± 17 mg/dL aggressive; P < 0.0001). Patients with aggressive control had a higher incidence of hypoglycemic events (4 vs 30; P < 0.0001).

Conclusions: In diabetic patients undergoing CABG surgery, aggressive glycemic control increases the incidence of hypoglycemic events and does not result in any significant improvement in clinical outcomes that can be achieved with moderate control. Clinical Trials.gov (ID #NCT00460499)

This study sought to determine whether aggressive glycemic control (90–120 mg/dL) results in better outcomes than moderate glycemic control (120–180 mg/dL) in 82 diabetic patients undergoing CABG surgery. Aggressive glycemic control increased the incidence of hypoglycemic events but did not result in any significant improvement of clinical outcomes compared to moderate control.

*Departments of Cardiothoracic Surgery

Division of Endocrinology

Department of Biostatistics, Boston University School of Medicine and Boston Medical Center, Boston, MA

§Department of Exercise Science, University of Massachusetts Amherst, Amherst, MA.

Reprints: Harold L. Lazar, MD, Department of Cardiothoracic Surgery, Boston Medical Center, 88 E Newton St, Boston, MA 02118. E-mail: Harold.lazar@bmc.org.

Disclosure: Supported by a research grant by Eli Lilly, Inc, Indianapolis, IN, and a grant from the Boston University Clinical and Translational Science Institute CTICTSI:UL1RR025771.

Presented at the 131st Annual Meeting of the American Surgical Association, April 14–16, 2011, Boca Raton, FL.

The authors declare no conflicts of interest.

© 2011 Lippincott Williams & Wilkins, Inc.