title: Association of time in blood glucose range with outcomes following cardiac surgery.
abstract: BACKGROUND
  The importance of optimal postoperative glycemic control in cardiac patients remains unclear. Various glycemic targets have been prescribed to reduce wound infection and overall mortality rates.
  
  
  OBJECTIVE
  To assess glucose control, as determined by time in range (TIR), in patients with glycemic targets of 6.0 to 8.1 mmol/L, and to determine factors related to poor control.
  
  
  METHODS
  This prospective descriptive study evaluated 227 consecutive patients, 100 with and 127 without diabetes, after cardiac surgery. Patients received insulin to target glucose concentrations of 6.0 to 8.1 mmol/L. Data analyzed included patient age, gender, race, Euro score, cardiopulmonary bypass time (CPB), aortic cross clamp time (ACC), length of ventilation, stay in the intensive care unit (ICU) and stay in the hospital. Patients were divided into two groups, those who maintained > 80% and < 80% TIR. Outcome variables were compared in diabetics and non-diabetics.
  
  
  RESULTS
  Patients with >80% and <80% TIR were matched in age, sex, gender, and Euro score. Failure to maintain target glycemia was significantly more frequent in diabetics (p = 0.001), in patients with glycated hemoglobin (HbA1c) > 8% (p = 0.0001), and in patients taking dopamine (p = 0.04) and adrenaline (p = 0.05). Times of CPB and ACC, length of stay in the ICU and ventilation were significantly higher in patients with TIR <80% than >80%. Rates of hypoglycemia, acute kidney injury, and in-hospital mortality were similar in the two groups, although the incidence of wound infection was higher in patients with TIR <80%. Both diabetics and non-diabetics with low TIR had poorer outcomes, as shown by length of stay and POAF. No significant differences were found between the two ethnic groups (Arabs and Asians).
  
  
  CONCLUSIONS
  Patients with >80% TIR, whether or not diabetics, had better outcomes than those with <80% TIR, as determined by wound infection, lengths of ventilation and ICU stay. Additionally, they were not subject to frequent hypoglycemic events. Preoperatively high HbA1C is likely a good predictor of poor glycemic control.
authors: Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, PO: 3050, Qatar ; Department of Critical Care Medicine, Beni Suef University, Beni Suef, Egypt.
authors: Amr S
authors: AS
authors: Omar
authors: Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, PO: 3050, Qatar ; Department of Anesthesia, Al-Azhar University, Cairo, Egypt.
authors: Ahmed
authors: A
authors: Salama
authors: Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, PO: 3050, Qatar ; Department of Anesthesia, Al-Azhar University, Cairo, Egypt.
authors: Mahmoud
authors: M
authors: Allam
authors: Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, PO: 3050, Qatar.
authors: Yasser
authors: Y
authors: Elgohary
authors: Department of Clinical Pharmacy, Hamad Medical Corporation, Doha, Qatar.
authors: Shaban
authors: S
authors: Mohammed
authors: Department of Cardiothoracic Surgery/Cardiac Anaesthesia & ICU Section, Heart Hospital, Hamad Medical Corporation, Doha, PO: 3050, Qatar.
authors: Alejandro Kohn
authors: AK
authors: Tuli
authors: Department of Medial Research, Hamad Medical Corporation, Doha, Qatar.
authors: Rajvir
authors: R
authors: Singh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D018912:Arabs; D044466:Asian People; D001786:Blood Glucose / Q000378:metabolism*; D006348:Cardiac Surgical Procedures; D016022:Case-Control Studies; D003920:Diabetes Mellitus / Q000097:blood / Q000601:surgery; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007003:Hypoglycemia / Q000150:complications / Q000453:epidemiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011780:Qatar / Q000453:epidemiology; D012121:Respiration, Artificial; D013997:Time Factors; D016896:Treatment Outcome; D014946:Wound Infection / Q000150:complications / Q000453:epidemiology*
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin
keywords: Glucose control; Outcome; Wound infection