Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial
Open accessAbstract
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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Lower glycosylated hemoglobin levels in cardiac surgery patients are associated with lower early and late mortality and lower incidence of postoperative acute kidney injury, neurologic complications, and wound infections.
“Lower levels of glycosylated hemoglobin in patients undergoing cardiac surgery are associated with a lower risk of early and late mortality, as well as in the incidence of postoperative acute kidney injury (AKI), neurologic complications, and wound infections.98,99”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [98]
The Introduction reports higher mortality, wound infections, renal failure, and postoperative strokes in cardiac-surgery patients with diabetes, as well as reduced long-term survival. The Results report higher admission HbA1c in patients with diabetes and higher hospital mortality and acute kidney injury in that group. Neither passage establishes that lower HbA1c itself is associated with each listed outcome, particularly late mortality, neurologic complications, and wound infections; the trial compared postoperative blood-glucose targets, not HbA1c levels. (LLM, conf=0.84)
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References 37 · Cited by 281
- Authors
- Umpierrez, G., Cardona, S., Pasquel, F., Jacobs, S., Peng, L., Unigwe, M., Newton, C. A., Smiley-Byrd, D., Vellanki, P., Halkos, M., Puskas, J. D., Guyton, R. A., & Thourani, V. H.
- Affiliations
- Emory University (US)
- Department of Medicine, Emory University, Atlanta, GA
- Corresponding author
- Umpierrez, Guillermo
- ORCID
- Venue
- Diabetes Care
- Publisher
- American Diabetes Association
- Published
- 2015-07-15
- Volume
- 38
- Issue
- 9
- Pages
- 1665-1672
- ISSN
- 0149-5992 (ISSN-L)
- 1935-5548
- PMC
- PMC4542267
- OpenAlex
- W2123467977
- Cited by
- 281
- References
- 37
- Citations by year
- 2026: 13 · 2025: 22 · 2024: 27 · 2023: 27 · 2022: 30 · 2021: 29 · 2020: 27 · 2019: 23 · 2018: 24 · 2017: 26 · 2016: 28 · 2015: 4 · 2013: 1
- FWCI
- 23.70
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Diabetes Care (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- American Diabetes Association (7-03-CR-35)
- National Institutes of Health (UL1 RR025008)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Intensive Care Unit Cognitive Disorders
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Keywords
- tight glycemic control, coronary artery bypass grafting, hyperglycemia, diabetes mellitus, insulin therapy, perioperative complications, postoperative mortality, intensive care unit, subgroup analysis
- MeSH terms
- Adult, Aged, Aged, 80 and over, Coronary Artery Bypass, Blood Glucose, Diabetes Mellitus, Female, Humans, Hyperglycemia, Insulin, Male, Middle Aged, Prospective Studies, Treatment Outcome, Young Adult, Intention to Treat Analysis
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