title: Perioperative Tight Glucose Control Reduces Postoperative Adverse Events in Nondiabetic Cardiac Surgery Patients.
abstract: BACKGROUND
  Tight glucose control (TGC) reduces morbidity and mortality in patients undergoing elective cardiac surgery, but only limited data about its optimal timing are available to date.
  
  
  OBJECTIVE
  The purpose of this article was to compare the effects of perioperative vs postoperative initiation of TGC on postoperative adverse events in cardiac surgery patients.
  
  
  METHODS
  This was a single center, single-blind, parallel-group, randomized controlled trial.
  
  
  METHODS
  The setting was an academic tertiary hospital.
  
  
  METHODS
  Participants were 2383 hemodynamically stable patients undergoing major cardiac surgery with expected postoperative intensive care unit treatment for at least 2 consecutive days.
  
  
  METHODS
  Intensive insulin therapy was initiated perioperatively or postoperatively with a target glucose range of 4.4 to 6.1 mmol/L.
  
  
  METHODS
  Adverse events from any cause during postoperative hospital stay were compared.
  
  
  RESULTS
  In the whole cohort, perioperatively initiated TGC markedly reduced the number of postoperative complications (23.2% vs 34.1%, 95% confidence interval [CI], 0.60-0.78) despite only minimal improvement in glucose control (blood glucose, 6.6 ± 0.7 vs 6.7 ± 0.8 mmol/L, P < .001; time in target range, 39.3% ± 13.7% vs 37.3% ± 13.8%, P < .001). The positive effects of TGC on postoperative complications were driven by nondiabetic subjects (21.3% vs 33.7%, 95% CI, 0.54-0.74; blood glucose 6.5 ± 0.6 vs 6.6 ± 0.8 mmol/L, not significant; time in target range, 40.8% ± 13.6% vs 39.7% ± 13.8%, not significant), whereas no significant effect was seen in diabetic patients (29.4% vs 35.1%, 95% CI, 0.66-1.06) despite significantly better glucose control in the perioperative group (blood glucose, 6.9 ± 1.0 vs 7.1 ± 0.8 mmol/L, P < .001; time in target range, 34.3% ± 12.7% vs 30.8% ± 11.5%, P < .001).
  
  
  CONCLUSIONS
  Perioperative initiation of intensive insulin therapy during cardiac surgery reduces postoperative morbidity in nondiabetic patients while having a minimal effect in diabetic subjects.
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Jan
authors.initials: J
authors.lastname: Bláha
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Miloš
authors.initials: M
authors.lastname: Mráz
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Petr
authors.initials: P
authors.lastname: Kopecký
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Stříteský
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Michal
authors.initials: M
authors.lastname: Lipš
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Michal
authors.initials: M
authors.lastname: Matias
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Jan
authors.initials: J
authors.lastname: Kunstýř
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Michal
authors.initials: M
authors.lastname: Pořízka
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Tomáš
authors.initials: T
authors.lastname: Kotulák
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Ivana
authors.initials: I
authors.lastname: Kolníková
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Barbara
authors.initials: B
authors.lastname: Šimanovská
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Mykhaylo
authors.initials: M
authors.lastname: Zakharchenko
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Jan
authors.initials: J
authors.lastname: Rulíšek
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Robert
authors.initials: R
authors.lastname: Šachl
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Jiří
authors.initials: J
authors.lastname: Anýž
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Daniel
authors.initials: D
authors.lastname: Novák
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Lindner
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Roman
authors.initials: R
authors.lastname: Hovorka
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Štěpán
authors.initials: Š
authors.lastname: Svačina
authors.affiliation: Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Haluzík
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods* / Q000706:statistics & numerical data; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D006331:Heart Diseases / Q000453:epidemiology / Q000601:surgery; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D019990:Perioperative Care / Q000379:methods*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000517:prevention & control*; D016037:Single-Blind Method; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin; D005947:Glucose