title: Comparison of glycemic and surgical outcomes after change in glycemic targets in cardiac surgery patients.
abstract: OBJECTIVE
  To compare perioperative glycemic and long-term surgical outcomes in patients undergoing cardiac surgery before and after the recommended 2009 changes in inpatient glycemic targets.
  
  
  METHODS
  We performed a retrospective review of patients who underwent cardiac surgery between 4 September 2007 and 30 April 2011. Comparison was made of blood glucose (BG) outcomes 3 days after surgery, and 30-day cardiac outcomes before and after a change in insulin protocol that took place on 1 September 2009, which consisted of raising the glycemic targets during intravenous insulin infusions from 80-110 mg/dL (80-110 group) to 110-140 mg/dL (110-140 group).
  
  
  RESULTS
  When compared with the 80-110 group (n = 667), the 110-140 group (n = 658) had higher mean postoperative BG levels during the intravenous insulin infusion (141 ± 15 vs. 121 ± 15 mg/dL, P < 0.001) and the subcutaneous insulin period (134 ± 24 vs. 130 ± 23 mg/dL, P < 0.001), and for 3 days postoperatively (141 ± 17 vs. 127 ± 15 mg/dL, P < 0.001). Fewer patients in the 110-140 mg/dL group experienced moderate hypoglycemia (BG <70 mg/dL) (177 vs. 73, P = 0.04). Severe hypoglycemia (BG <40 mg/dL) occurred in only one patient in the 80-110 group and three patients in the 110-140 group. There were no significant differences in mortality or surgical complication rates (with the exception of reintubation) between the groups.
  
  
  CONCLUSIONS
  The higher glycemic target of 110-140 mg/dL resulted in similar mean glucose values, with significantly less hypoglycemia and no significant differences in mortality/morbidity compared with the more strict target of 80-110 mg/dL.
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Irena
authors.initials: I
authors.lastname: Mulla
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Schmidt
authors.affiliation: Division of Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: John
authors.initials: J
authors.lastname: Cashy
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Amisha
authors.initials: A
authors.lastname: Wallia
authors.affiliation: Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Adin-Cristian
authors.initials: AC
authors.lastname: Andrei
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Diana
authors.initials: D
authors.lastname: Johnson Oakes
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Grazia
authors.initials: G
authors.lastname: Aleppo
authors.affiliation: Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Carrie
authors.initials: C
authors.lastname: Li
authors.affiliation: Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Grady
authors.affiliation: Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Edwin
authors.initials: E
authors.lastname: McGee
authors.affiliation: Division of Endocrinology, Metabolism and Molecular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL molitch@northwestern.edu.
authors.forename: Mark E
authors.initials: ME
authors.lastname: Molitch
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000032:analysis*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000453:epidemiology; D007003:Hypoglycemia / Q000453:epidemiology; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007328:Insulin / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D012189:Retrospective Studies
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin