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

• Authors: Guillermo Umpierrez, Emory University; Saumeth Cardona, Emory University; Francisco Javier Pasquel, Emory University; Sol Jacobs, Emory University; Limin Peng, Emory University; Michael Unigwe, Emory University; Christopher A. Newton, Emory University; Dawn Smiley, Emory University; Priyathama Vellanki, Emory University; Michael Halkos, Emory University; John D. Puskas, Emory University; Vinod Thourani, Emory University; Robert A Guyton, Emory University
• Journal Title: Diabetes Care
• Volume: Volume 38, Number 9
• Publisher: American Diabetes Association | 2015-09-01, Pages 1665-1672
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.2337/dc15-0303
• Keywords: Science & Technology; Life Sciences & Biomedicine; Endocrinology & Metabolism; CRITICALLY-ILL PATIENTS; INSULIN THERAPY; GLYCEMIC CONTROL; HOSPITALIZED-PATIENTS; DIABETES-MELLITUS; PERIOPERATIVE HYPERGLYCEMIA; CLINICAL-OUTCOMES; ADVERSE EVENTS; MORTALITY; HYPOGLYCEMIA

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.