Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in

Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCOCABG Trial

Featured Article:

Guillermo Umpierrez, Saumeth Cardona, Francisco Pasquel, Sol Jacobs,Limin Peng, Michael Unigwe, Christopher A. Newton, Dawn Smiley-Byrd,

Priyathama Vellanki, Michael Halkos, John D. Puskas, Robert A. Guyton, and Vinod H. Thourani

Diabetes Care Volume 38: 1665-1672

September, 2015

STUDY OBJECTIVE 

• The optimal level of glycemic control needed to improve outcomes in cardiac surgery patients remains controversial

Umpierrez G. et al. Diabetes Care 2015;38:1665-1672

STUDY DESIGN AND METHODS• After coronary artery bypass (CABG) surgery, patients with and without

diabetes with hyperglycemia were randomized to two groups:• An intensive glucose target of 100–140 mg/dL• A conservative target of 141–180 mg/dL

• 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• Major cardiovascular events

Umpierrez G. et al. Diabetes Care 2015;38:1665-1672

RESULTS

• Mean glucose in the ICU was 132 ± 14 mg/dL in the intensive and 154 ± 17 mg/dL in the conservative group

• There were no significant differences in the composite of complications between intensive and conservative groups

• No differences in complications occurred among patients with diabetes treated with intensive or conservative regimens

• There was a significantly lower rate of complications in patients without diabetes treated with intensive compared with conservative treatment regimen

Umpierrez G. et al. Diabetes Care 2015;38:1665-1672

Umpierrez G. et al. Diabetes Care 2015;38:1665-1672

Umpierrez G. et al. Diabetes Care 2015;38:1665-1672

Umpierrez G. et al. Diabetes Care 2015;38:1665-1672

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

• There was a lower number of complications in patients without diabetes, but not in patients with diabetes treated with the intensive regimen

Umpierrez G. et al. Diabetes Care 2015;38:1665-1672

Umpierrez G. et al. Diabetes Care 2015;38:1665-1672