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Randomized Controlled Trial
. 2015 Sep;38(9):1665-72.
doi: 10.2337/dc15-0303. Epub 2015 Jul 15.

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

Guillermo Umpierrez  1 , Saumeth Cardona  2 , Francisco Pasquel  2 , Sol Jacobs  2 , Limin Peng  3 , Michael Unigwe  2 , Christopher A Newton  2 , Dawn Smiley-Byrd  2 , Priyathama Vellanki  2 , Michael Halkos  4 , John D Puskas  4 , Robert A Guyton  4 , Vinod H Thourani  4
Affiliations
Randomized Controlled Trial

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

Guillermo Umpierrez et al. Diabetes Care. 2015 Sep.

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 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.

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Figures

Figure 1
Figure 1
Mean glucose concentration and frequency of hypoglycemia in patients treated to intensive and conservative glucose targets. Cardiac surgery patients with hyperglycemia were randomized to an intensive glucose target (100–140 mg/dL) or to a conservative target (141–180 mg/dL). A: Mean glucose concentration on admission, during surgery (OR), randomization, ICU stay and CII, non-ICU hospital stay, and after hospital discharge. B: Frequency of hypoglycemia in the ICU and during CII, non-ICU hospital stay, and after hospital discharge. Open bars, intensive control; filled bars, conservative control. *P < 0.001; ≠P < 0.05.
Figure 2
Figure 2
Composite of perioperative complications in patients treated to intensive and conservative glucose targets. Cardiac surgery patients with hyperglycemia were randomized to intensive (100–140 mg/dL) or conservative (141–180 mg/dL) glucose targets. The primary outcome was differences in a composite of hospital complications, including mortality, wound infection, pneumonia, bacteremia, respiratory failure, acute kidney injury, and MACE. A: Composite of perioperative complications in all patients treated with intensive and conservative glucose targets. B: Composite of perioperative complications in patients with diabetes treated with intensive and conservative glucose targets. C: Composite of perioperative complications in patients without diabetes treated with intensive and conservative glucose targets. Open bars, intensive glucose target; filled bars, conservative glucose target. AKI, acute kidney injury.
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References

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