Guillermo Umpierrez, Saumeth Cardona, Francisco Pasquel, Sol Jacobs,

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Guillermo Umpierrez, Saumeth Cardona, Francisco
Pasquel, Sol Jacobs, Limin Peng, Michael Unigwe,
Christopher A. Newton, Dawn Smiley-Byrd,
Priyathama Vellanki, Michael Halkos, John D.
Puskas, Robert A. Guyton, and Vinod H. Thourani
Diabetes Care Volume 38 1665-1672 September,
2015
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STUDY OBJECTIVE  

• The optimal level of glycemic control needed to
  improve outcomes in cardiac surgery patients
  remains controversial

Umpierrez G. et al. Diabetes Care
2015381665-1672
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STUDY DESIGN AND METHODS

• After coronary artery bypass (CABG) surgery,
  patients with and without diabetes with
  hyperglycemia were randomized to two groups
• An intensive glucose target of 100140 mg/dL
• A conservative target of 141180 mg/dL
• 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
• Major cardiovascular events

Umpierrez G. et al. Diabetes Care
2015381665-1672
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RESULTS

• Mean glucose in the ICU was 132 14 mg/dL in the
  intensive and 154 17 mg/dL in the conservative
  group
• There were no signi?cant differences in the
  composite of complications between intensive and
  conservative groups
• No differences in complications occurred among
  patients with diabetes treated with intensive or
  conservative regimens
• There was a signi?cantly lower rate of
  complications in patients without diabetes
  treated with intensive compared with conservative
  treatment regimen

Umpierrez G. et al. Diabetes Care
2015381665-1672
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Umpierrez G. et al. Diabetes Care
2015381665-1672
6
Umpierrez G. et al. Diabetes Care
2015381665-1672
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Umpierrez G. et al. Diabetes Care
2015381665-1672
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CONCLUSIONS

• Intensive insulin therapy to target glucose of
  100 and 140 mg/dL in the ICU did not signi?cantly
  reduce perioperative complications compared with
  target glucose of 141 and 180 mg/dL after CABG
  surgery
• There was a lower number of complications in
  patients without diabetes, but not in patients
  with diabetes treated with the intensive regimen

Umpierrez G. et al. Diabetes Care
2015381665-1672
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Umpierrez G. et al. Diabetes Care
2015381665-1672