Effects of moderate intensity glycemic control after cardiac surgery

Gil Leibowitz*, Ela Raizman, Mayer Brezis, Benjamin Glaser, Itamar Raz, Oz Shapira

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

34 Scopus citations


Background The impact of intensive insulin therapy on the clinical outcomes of hospitalized patients is highly controversial. We used a protocol based on dynamic insulin administration targeted to achieve moderately tight glycemic control and tested its impact on clinical outcomes after cardiac surgery. Methods Patients with diabetes mellitus or random blood glucose greater than 150 mg/dL were treated in the intensive care unit with intravenous insulin, followed by a multi-injection protocol consisting of 4 glargine/aspart insulin injections in the ward, with a glycemic target of 110 to 150 mg/dL. The study cohort (n = 410) consisted of consecutive patients undergoing cardiothoracic surgery. Control patients (n = 207) were admitted during the first 8 months and treated according to standard of care. The intervention group of patients (n = 203) were operated on during the following 8 months. The main outcome measures were glycemic control and the rate of postsurgery infections. Results During the intervention, mean blood glucose ± SD was 151 ± 19 mg/dL and 157 ± 32 mg/dL in the intensive care unit and ward, respectively, versus 166 ± 27 mg/dL and 184 ± 46 mg/dL during the control period (p < 0.0001). The incidence of hypoglycemia (blood glucose less than 60 mg/dL) was low and similar in the two groups (2.5% control versus 3% intervention). Intensive insulin treatment decreased the risk for infection from 11% to 5% (56% risk reduction, p = 0.018), mainly by reducing the incidence of graft harvest site infection (6.9% versus 2.5%, p = 0.034). The incidence of atrial fibrillation after coronary artery bypass graft surgery decreased from 30% to 18% (39% risk reduction; p = 0.042). Conclusions Moderate-intensity dynamic blood glucose control after cardiac surgery is effective and safe, and is associated with improved clinical outcomes.

Original languageAmerican English
Pages (from-to)1825-1832
Number of pages8
JournalAnnals of Thoracic Surgery
Issue number6
StatePublished - Dec 2010
Externally publishedYes


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