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Stricter Glycemic Control after Coronary Artery Bypass Surgery Evaluated

Prospective study shows that maintenance of glucose levels in a liberal target range is safer and more beneficial than a tight target range after CABG…

Hyperglycemia after coronary artery bypass graft (CABG) has been associated with increased mortality but according to recent studies, regulating glucose levels in a liberal target range is more advantageous than a tight target range in patients after CABG.

This study was a prospective design as a follow-up program after surgery. It included patients with a mean age of 62.7 years randomly assigned to a strict glucose control method (90-120mg/dL) or to a liberal method (121-180mg/dL). The primary outcome was to determine the association between method of glycemic control and long-term survival after the CABG. The researchers also looked at health-related quality of life.

Pezzella and colleagues found no differences in cumulative survival between the strict (95.5%) and liberal (93.5%) target range groups (log-rank = 0.32, p = 0.57) over a mean follow-up of 40.0 ± 4.4 months. Physical health-related quality of life significantly improved in all patients from baseline to 6 months after surgery (F = 17.73, p < 0.001), and there were no differences in improvement of health-related quality of life between the 2 target range groups (F = 0.15, p = 0.70). of life (P=0.7). The health-related quality of life improved in all patients.

Overall, there was no significant difference in survival rate in patients with stricter glycemic control or with liberal glycemic control. The Society of Thoracic Surgeons recommends target maintenance glucose levels

Practice Pearls:

  • This study looked at survival rate in patients following strict glycemic control (90-120mg/dL) compared to liberal glycemic control (121-180mg/dL) after the CABG.
  • There was no significant difference in both groups (95.5% increased in patients with strict control and 93.5% in patients with liberal control).
  • According to researchers, a target glucose level <180mg/dL after CABG is sufficient and this can also decrease the consequences of hypoglycemia associated with tight control.

Pezzella, Thomas, et al “Impact of Perioperative Glycemic Control Strategy on Patient Survival After Coronary Bypass Surgery.” The Society of Thoracic Surgeons. (2014);98:1281-1285.