Conventional Glycaemic Control May Not Be Beneficial in Diabetic Patients Following Cardiac Surgery

Bayfield, Nicholas; Bibo, Liam; Budgeon, Charley; Larbalestier, Robert; Briffa, Tom

doi:10.1016/j.hlc.2022.08.013

Cited by 2 publications

(1 citation statement)

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“…A previous meta-analysis including 12 965 patients from 11 cohort studies showed that diabetes may be an independent risk factor of mortality in patients after coronary artery bypass graft (CABG) [3]. Subsequent studies indicated that the influence of diabetes on the prognosis of patients after cardiac surgery is complicated, which may also be influenced by the strategy of blood control [4,5]. It was shown that compared with moderate glycemic control strategy (7.8-10.0 mmol/l) in patients with diabetes undergoing cardiac surgery, who maintained strict glycemic control (7.8 mmol/l), was associated with lower risk of atrial fibrillation (AF) and sternal wound infection, although there was no significant differences in postoperative mortality, stroke, and hypoglycemic episodes [6].…”

Section: Introductionmentioning

confidence: 99%

Acute Glycemic Variability and Early Outcomes After Cardiac Surgery: A Meta-Analysis

Chang

Wang

et al. 2023

Horm Metab Res

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The influence of acute glycemic variability (GV) on early outcomes of patients after cardiac surgery remains not fully determined. We performed a systematic review and meta-analysis to evaluate the association between acute GV and in-hospital outcomes of patients after cardiac surgery. Relevant observational studies were obtained by search of electronic databases including Medline, Embase, Cochrane Library, and Web of Science. A randomized-effects model was selected to pool the data by incorporating the influence of potential heterogeneity. Nine cohort studies involving 16 411 patients after cardiac surgery were included in this meta-analysis. Pooled results showed that a high acute GV was associated with an increased risk of major adverse events (MAE) during hospitalization for patients after cardiac surgery [odds ratio [OR]: 1.29, 95% CI: 1.15 to 1.45, p<0.001, I22=38%]. Sensitivity analysis limited to studies of on-pump surgery and GV evaluated by coefficient of variation of blood glucose showed similar results. Subgroup analysis suggested that a high acute GV was related to an increased incidence of MAE in patients after coronary artery bypass graft, but not for those after isolated valvular surgery (p=0.04), and the association was weakened after adjustment of glycosylated hemoglobin (p=0.01). Moreover, a high acute GV was also related to an increased risk of in-hospital mortality (OR: 1.55, 95% CI: 1.15 to 2.09, p=0.004; I22=0%). A high acute GV may be associated with poor in-hospital outcomes in patients after cardiac surgery.

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Section: Introductionmentioning

confidence: 99%