HbA1c and diabetes predict perioperative hyperglycemia and glycemic variability in on-pump coronary artery bypass graft patients.
OBJECTIVE
Perioperative hyperglycemia and glycemic variability are considered independent predictors of morbidity and mortality in critically ill patients. The purpose of this study was to investigate the relation of HbA1c and/or a prior diagnosis of diabetes mellitus and intra- and postoperative hyperglycemia and glycemic variability.


METHODS
A retrospective data analysis from a single-center database.


METHODS
A single university hospital.


METHODS
Diabetic and nondiabetic patients undergoing isolated on-pump coronary artery bypass graft (CABG) surgery.


METHODS
One hundred twenty patients undergoing isolated CABG surgery were evaluated. Glucose values were acquired pre-, intra-, and postoperatively on the day of surgery as well as on the first postoperative day. The extent of hyperglycemia within and between groups was compared using mean and maximum glucose values. As a measure of the patient's individual intra- and postoperative glucose variability, the standard deviation (SD) and the coefficient of variation (CV) of glucose values were calculated. Outcomes were analyzed using a multiple logistic regression model.


RESULTS
Diabetics and/or patients with elevated HbA1c had higher postoperative glucose levels, a higher SD, and a higher CV of postoperative glucose values; however, higher glucose variability was not associated with higher rates of complication. Intraoperative glucose values and variation did not differ significantly between groups. Increased mean blood glucose values were associated with increased risk of infection.


CONCLUSIONS
Diabetic status and/or elevated HbA1c are predictors of postoperative glucose variability and hyperglycemia in CABG surgery patients. However, in the intraoperative period, these groups show similar glycemic responses to operative stress.
Department of Anesthesiology, University of Virginia, Charlottesville, VA 22908-0710, USA.
Matthias
M
Masla
Antje
A
Gottschalk
Marcel E
ME
Durieux
Danja S
DS
Groves
D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D001026:Coronary Artery Bypass / Q000401:mortality; D003920:Diabetes Mellitus / Q000097:blood*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis*; D006801:Humans; D006943:Hyperglycemia / Q000097:blood* / Q000175:diagnosis; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011237:Predictive Value of Tests; D012189:Retrospective Studies
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents; D007328:Insulin