Association Between Perioperative Glycemic Control Strategy and Mortality in Patients With Diabetes Undergoing Cardiac Surgery: A Systematic Review and Meta-Analysis

Abstract

ObjectiveTo analyze association between different perioperative glycemic control strategies and postoperative outcomes in patients with diabetes undergoing cardiac surgery.MethodsMEDLINE, Cochrane Library, Web of Science, EMBASE, Wanfang Data, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM) databases were searched from inception to January 31, 2019. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of included studies, and consensus was reached by discussion with a third researcher.ResultsSix RCTs were included in the meta-analysis. We analyzed the effect of liberal (>180 mg/dl or 10.0 mmol/L), moderate (140–180 mg/dl or 7.8–10.0 mmol/L) and strict (<140 mg/dl or 7.8 mmol/L) glycemic control strategies in patients with diabetes undergoing cardiac surgery. The pooled results showed that strict glycemic control strategy was associated with a significant reduction in the risk of atrial fibrillation [OR = 0.48, 95%CI (0.32, 0.72), P < 0.001] and sternal wound infection [OR = 0.28, 95%CI (0.14, 0.54), P < 0.001], while there was no significant differences in postoperative mortality, stroke, and hypoglycemic episodes when compared with moderate control. In addition, there is no significant difference between moderate and liberal glycemic control strategies in postoperative mortality. However, moderate control was beneficial in reducing atrial fibrillation [OR = 0.28, 95%CI (0.13, 0.60), P = 0.001] compared with the liberal glycemic control strategy.ConclusionsThis meta-analysis showed when compared with moderate glycemic control strategy in patients with diabetes undergoing cardiac surgery, maintained strict glycemic control was associated with lower risk of atrial fibrillation and sternal wound infection. No benefit was found with liberal glycemic control strategy, so it could be a poor glycemic control strategy.

Nosocomial Extracardiac Infections After Cardiac Surgery

“…It is equally important the maintenance of the glycemic stability; indeed, systematic reviews of several studies investigating control protocols (through the use of continuous insulin infusion) to maintain an optimal range of glycemia (< 140 mg/dl or 7.8 mmol/L), demonstrated fewer potential complications in patients with diabetes undergoing cardiac surgery [ 64 , 65 ].…”

Position statement: surgery and diabetes mellitus (Update 2023)

“…Hierbei wird insbesondere auf die präoperative Evaluierung des Gesundheitsstatus der Menschen mit Diabetes mellitus, die präoperative Stoffwechselkontrolle und das perioperative Management inklusive medikamentöser Diabetestherapie und mögliche Komplikationen eingegangen. Nachdem es zu einem globalen Anstieg der Diabetes Prävalenz und Inzidenz kommt, ist konkordant auch die Anzahl von Patient:innen mit Diabetes, die eine Operation brauchen, zunehmend [1,2]. Zu zahlreichen wichtigen Fragestellungen dieses Themenkomplexes liegen nur vereinzelte oder gar keine randomisierten prospektiven Studien bzw.…”

Commentary: Addressing glycemic load in the precardiac surgical period: Does one size fit all?

“…Whether this approach could be implemented in patients without diabetes and poorly controlled glycemic status requires investigation. 7,8 Other strategies for people with a surgical waitlist may benefit from exercise training to improve long-term glycometabolic status. Yet, observational studies and preoperative exercise therapy trials have not demonstrated efficacy to modulate glycemic status in the presurgical period.…”