Effect of glycemic control and glucose fluctuation on in-hospital adverse outcomes after on-pump coronary artery bypass grafting in patients with diabetes: a retrospective study

Abstract

Background The optimal glycemic control level in diabetic patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (On-Pump) remains unclear. Therefore, this study aimed to investigate the effect of different blood glucose control levels and glucose fluctuations on in-hospital adverse outcomes in diabetic patients undergoing on-pump CABG. Method A total of 3918 patients with diabetes undergoing CABG were reviewed in this study. A total of 1638 patients were eligible for inclusion and were categorized into strict, moderate and liberal glucose control groups based on post-operative mean blood glucose control levels of < 7.8 mmol/L, from 7.8 to 9.9 mmol/L and ≥ 10.0 mmoL/L, respectively. The primary endpoint was defined as a composite endpoint including in-hospital all-cause mortality and major cardiovascular complications. The secondary endpoint was defined as major cardiovascular complications including acute myocardial infarction, strokes and acute kidney injuries. To determine the associations between blood glucose fluctuations and adverse outcomes, patients with different glycemic control levels were further divided into subgroups according to whether the largest amplitude of glycemic excursion (LAGE) was ≥ 4.4 mmol/L or not. Results A total of 126 (7.7%) patients had a composite endpoint. Compared with moderate control, strict glucose control was associated with an increased risk of the primary endpoint (adjusted OR = 2.22, 95% CI 1.18–4.15, p = 0.01) and the secondary endpoint (adjusted OR = 1.95, 95% CI 1.01–3.77, p = 0.049). Furthermore, LAGE ≥ 4.4 mmol/L was significantly associated with the primary endpoint (adjusted OR = 1.67, 95% CI 1.12–2.50, p = 0.01) and the secondary endpoint (adjusted OR = 1.75, 95% CI 1.17–2.62, p = 0.01),respectively. Patients with LAGE ≥ 4.4 mmol/L had significantly higher rates of the composite endpoint and major vascular complications in both the strict-control (the primary endpoint, 66.7% vs 12.4%, p = 0.034, the secondary endpoint, 66.7% vs 10.3%, p = 0.03) and moderate-control groups (the primary endpoint, 10.2% vs 6.0%, p = 0.03, the secondary endpoint, 10.2% vs 5.8%, p = 0.02). Conclusions After On-Pump CABG patients with diabetes, strict glucose control (< 7.8 mmol/L) and relatively large glucose fluctuations (LAGE ≥ 4.4 mmol/L) were independently associated with in-hospital adverse outcomes.

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

“…1. Finally, nine observational studies [16][17][18][19][20][21][22][23][24] were included in the meta-analysis.…”

“…Pooled results of nine studies 16 17 18 19 20 21 22 23 24 showed that a high acute GV was associated with an increased risk of MAE during hospitalization for patients after cardiac surgery (OR: 1.29, 95% CI: 1.15 to 1.45, p<0.001; Fig. 2a ) with mild heterogeneity (p for Cochrane Q-test=0.12, I 2 =38%).…”

“…Pooled results of nine studies [16][17][18][19][20][21][22][23][24] showed that a high acute GV was associated with an increased risk of MAE during hospitalization for patients after cardiac surgery (OR: 1. 3).…”

“…As shown in ▶table 1, three prospective cohort studies [17,18,21], and six retrospective cohort studies [16,19,20,[22][23][24] were included in the meta-analysis. These studies were published between 2010 and 2023 and performed in the United States, Korea, and China, respectively.…”

“…However, the influence of acute GV in perioperative period on the in-hospital outcomes of patients after cardiac surgery remains not fully determined [14,15]. Although several pilot studies have been performed, the results of these studies are not always consistent [16][17][18][19][20][21][22][23][24]. Accordingly, we performed a systematic review and meta-analysis to evaluate the association between acute GV and in-hospital outcomes of patients after cardiac surgery.…”