Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery

Wahby, Ehab; Elnasr, Mohamed Mahmoud Abo; Eissa, Michael I.; Mahmoud, Sahbaa

doi:10.1016/j.jescts.2016.05.007

Cited by 15 publications

(19 citation statements)

References 32 publications

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“…The remaining 27 studies underwent a full text review with 21 studies excluded due to inclusion of nondiabetics, non-concerned comparison, or lack of concerned outcomes. Finally, six RCTs (20)(21)(22)(39)(40)(41) were finally included in this meta-analysis. References (n = 21) excluded after reading full-text are provided in Supplementary 2.…”

Section: Search Resultsmentioning

confidence: 99%

“…Six RCTs ( 20 – 22 , 39 – 41 ) all included patients with diagnosed diabetes, but they did not specify their diagnostic criteria. Five studies ( 20 – 22 , 40 , 41 ) only reported that their patients were diabetics, and one study ( 39 ) clearly reported that they included both type 1 and type 2 diabetic patients. All studies were published between 2004 and 2016; the sample sizes ranged from 75 to 200.…”

Section: Resultsmentioning

confidence: 99%

“…In addition, the glycemic targets varied between trials. There were five studies compared strict and moderate glycemic control strategies (20,21,(39)(40)(41), whereas the other one study compared moderate and liberal glycemic control strategies (22). All studies used insulin to control PG.…”

Section: Characteristics Of the Selected Studiesmentioning

confidence: 99%

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

Jin

Wang

et al. 2020

Front. Endocrinol.

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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.

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Section: Search Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

Jin

Wang

et al. 2020

Front. Endocrinol.

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“…We retrieved the full texts of the remaining 136 studies for further assessment, 28 of them meet our inclusion criteria, and then two studies were excluded because of zero events in both groups for all outcomes. Finally, the meta-analysis included 26 eligible studies involving a total of 9315 surgical patients ( 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 ). Figure 1 displayed the screening process.…”

Section: Resultsmentioning

confidence: 99%

Effects of perioperative tight glycemic control on postoperative outcomes: a meta-analysis

Kang¹,

Huo²,

Zhai³

2018

Endocrine Connections

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BackgroundThe optimal glycemic target during the perioperative period is still controversial. We aimed to explore the effects of tight glycemic control (TGC) on surgical mortality and morbidity.MethodsPubMed, EMBASE and CENTRAL were searched from January 1, 1946 to February 28, 2018. Appropriate trails comparing the postoperative outcomes (mortality, hypoglycemic events, acute kidney injury, etc.) between different levels of TGC and liberal glycemic control were identified. Quality assessments were performed with the Jadad scale combined with the allocation concealment evaluation. Pooled relative risk (RR) and 95% CI were calculated using random effects models. Heterogeneity was detected by the I2 test.ResultsTwenty-six trials involving a total of 9315 patients were included in the final analysis. The overall mortality did not differ between tight and liberal glycemic control (RR, 0.92; 95% CI, 0.78–1.07; I 2 = 20.1%). Among subgroup analyses, obvious decreased risks of mortality were found in the short-term mortality, non-diabetic conditions, cardiac surgery conditions and compared to the very liberal glycemic target. Furthermore, TGC was associated with decreased risks for acute kidney injury, sepsis, surgical site infection, atrial fibrillation and increased risks of hypoglycemia and severe hypoglycemia.ConclusionsCompared to liberal control, perioperative TGC (the upper level of glucose goal ≤150 mg/dL) was associated with significant reduction of short-term mortality, cardic surgery mortality, non-diabetic patients mortality and some postoperative complications. In spite of increased risks of hypoglycemic events, perioperative TGC will benefits patients when it is done carefully.

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“…Improved perioperative blood glucose control and the use of insulin perfusion may contribute to improved operative outcomes in diabetic patients [25]. Kuhl et al [26] in a study examining long-term outcomes after coronary bypass surgery in patients with type 2 diabetes mellitus suggested that mortality increased when HbA1c levels were>9% and morbidity and complications increased when the levels were>8.1%.…”

Section: Discussionmentioning

confidence: 99%

Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG

Elsayed¹,

Eid²

2019

IJCTS

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Objectives:The rising percentage of patients scheduled for primary CABG with HbA1c>8.6% is alarming reflecting higher burden on the patient, operative procedure and the operating surgeon. Although some articles in the literature argue that decompensated diabetes increases mortality and morbidity, other studies are arguing that there is no relation between them. This study aims at tracing the occurrence of the proposed adverse complications after primary CABG operations related to HbA1c values>8.6% in diabetics subjected to tight glycemic control; in a trial to conclude how far the value of HbA1c could be accepted to carry out the surgery safely. Methods:This prospective study included 80 adult diabetic patients who presented with IHD requiring primary CABG. It was conducted between January 2016 and December 2018. Group (I) included 42 patients with HbA1c values<8.6% and group (II) included 38 patients with HbA1c values>8.6%. We compared the following: perioperative MI, low cardiac output syndrome, operative mortality, rhythmic complications, hemorrhagic complications, respiratory complications, cerebrovascular accidents, acute renal failure development, superficial and deep surgical wounds infections, overall hospital complications and overall one-year mortality and survival. Results: Mean HbA1c% value was 7.5 ± 1.11% for group (I) and 9.3 ± 1.03% for group (II). Prior to surgery, the mean FBG level was 136.9±41.7 mg/dl for group (I) and 152.2±27.3 mg/dl for group (II) with tight glycemic control measures. Although group (II) showed higher values in the studied parameters (pre-, intra-and post-operatively), no statistically significant differences appeared between the two subsets of patients regarding the proposed adverse complications. The overall hospital complication rate was 13(30.95%) and 14(36.84%) for group (I) and (II) respectively (p>0.05). In the follow-up period, both groups expressed comparable results with no statistical significance. The overall one-year survival was 95.23% and 94.73% in group (I) and (II) respectively (p>0.05) and the overall mortality was 5% (two deaths from each group) (p>0.05). Conclusion:Although patients with IHD undergoing primary CABG and having decompensated diabetes with HbA1c values>8.6% have more insulted cardiovascular condition, these higher HbA1c values do not add more additional impact on the proposed adverse intra-and postoperative complications as with lower values with the aid of strict (tight) glycemic control measures in the immediate preoperative period.

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Perioperative glycemic control in diabetic patients undergoing coronary artery bypass graft surgery

Cited by 15 publications

References 32 publications

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

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

Effects of perioperative tight glycemic control on postoperative outcomes: a meta-analysis

Tracing the Proposed Adverse Effects of Higher Values of Glycosylated Hemoglobin (HbA1c) in Tightly-Controlled Diabetic Patients Undergoing Primary CABG

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