title: Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial.
abstract: OBJECTIVE
  The optimal level of glycemic control needed to improve outcomes in cardiac surgery patients remains controversial.
  
  
  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.
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA geumpie@emory.edu.
authors.forename: Guillermo
authors.initials: G
authors.lastname: Umpierrez
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Saumeth
authors.initials: S
authors.lastname: Cardona
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Francisco
authors.initials: F
authors.lastname: Pasquel
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Sol
authors.initials: S
authors.lastname: Jacobs
authors.affiliation: Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Limin
authors.initials: L
authors.lastname: Peng
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Michael
authors.initials: M
authors.lastname: Unigwe
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Newton
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Dawn
authors.initials: D
authors.lastname: Smiley-Byrd
authors.affiliation: Department of Medicine, Emory University, Atlanta, GA.
authors.forename: Priyathama
authors.initials: P
authors.lastname: Vellanki
authors.affiliation: Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Michael
authors.initials: M
authors.lastname: Halkos
authors.affiliation: Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, GA.
authors.forename: John D
authors.initials: JD
authors.lastname: Puskas
authors.affiliation: Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Guyton
authors.affiliation: Joseph B. Whitehead Department of Surgery, Emory University, Atlanta, GA.
authors.forename: Vinod H
authors.initials: VH
authors.lastname: Thourani
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose / Q000187:drug effects / Q000378:metabolism*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D007328:Insulin / Q000008:administration & dosage*; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007328:Insulin