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Adjusted tight control blood glucose management in diabetic patients undergoing on pump coronary artery bypass graft. A randomized clinical trial

Journal of Diabetes & Metabolic Disorders volume 19, pages 423–430 (2020)Cite this article

A Correction to this article was published on 07 February 2020

This article has been updated

Abstract

Background

Many of the patients who are undergoing Coronary Artery Bypass Graft have diabetes mellitus or metabolic syndrome and are at risk for hyperglycemia events.

Objective

The present study aimed to compare conventional glucose control with adjusted tight control in patients undergoing on-pump CABG.

Methods

This double –blind randomized clinical trial study was conducted in Shiraz, Iran, from September 2017–March 2018. Two consecutive groups of 75 patients undergoing elective on- pump coronary artery bypass graft surgery.

Intervention

The patients were divided into adjusted tight control of the blood glucose between 100 and 120 mg/dl and conventional method that the blood glucose maintained ≤200 mg/dl.

Primary outcomes were

mortality, sternal wound infection, cardiac arrhythmia, cerebrovascular attack, and acute renal failure.

Secondary outcomes included

duration of mechanical ventilation and length of ICU staying. The same main outcomes were evaluated after one month.

Statistical analysis

The data were analyzed using SPSS version 20(SPSS, Chicago, IL). Group comparisons were performed using t-tests and Chi-square tests. Repeated measurement test was used for comparing blood glucose in two groups. Mann Whitney U test was compared duration of the mechanical ventilation and length of ICU staying. Statistical significance was defined as a p value <0.05.

Results

There were no significant differences between main and secondary outcomes. About late outcomes, sternal wound infection was in the control group (7 patients) more than intervention (1 patient) (P < 0.05). No differences between other complications in both groups were observed. The occurrence of hypoglycemia was low in both groups. Hypokalemia was significantly higher in the intervention than in control (P < 0.001).

Conclusions

The findings showed using adjusted tight glycemic control to a level that is nearby to normal values during cardiac surgery may reduce episodes of hypoglycemia and thus reduces its side effects. As well as reduce hyperglycemic complications such as sternal wound infection.

Trial registration number

IRCT2013041713052N1). 2013-07-09.

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Data availability

Data are available on request to the corresponding author.

Change history

  • 07 February 2020

    The article ‘Adjusted tight control blood glucose management in diabetic patients undergoing on pump coronary artery bypass graft. A randomized clinical trial’, written by Fatemeh Javaherforoosh zadeh and Simin Azemati, was originally published electronically on the publisher’s internet portal.

Abbreviations

CABG:

Coronary Artery Bypass Graft

CVA:

cerebrovascular accident

TIA:

transient ischemic attacks

MDAS:

Memorial Delirium Assessment Scale

BS:

Blood glucose

AF:

Atrial Fibrillation

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Acknowledgements

We sincerely thank the patients who cooperated with us in this project and supported the research team.

Funding

Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences.

Author information

Affiliations

  1. Department of Anesthesia, Ahvaz Anesthesiology and Pain Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran

    Fatemeh Javaherforoosh zadeh

  2. Anesthesiology and Critical Care Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

    Simin Azemati

Authors
  1. Fatemeh Javaherforoosh zadeh
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  2. Simin Azemati
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Contributions

FJ and SA collaborated equally. They conceived and designed the analysis, and collected and analyzed the OCT-data; SA performed the statistical analysis. FJ and SA drafted the paper. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Fatemeh Javaherforoosh zadeh.

Ethics declarations

Ethics approval and consent to participate

All of the procedures of this study were approved by the local Ethics Committee of Shiraz University of Medical Sciences, Shiraz, Iran (Ethics code: 91–01-60-5268).

This study was designed as a placebo-controlled, clinical trial (Code: IRCTID: IRCT2013041713052N1. Informed consent form was obtained from all patients.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Conflicting interest

There is no conflict of interest to be declared.

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The article ‘Adjusted tight control blood glucose management in diabetic patients undergoing on pump coronary artery bypass graft. A randomized clinical trial’, written by Fatemeh Javaherforoosh zadeh and Simin Azemati, was originally published electronically on the publisher’s internet portal (currently SpringerLink) on 20th January 2020 with open access. With the author(s)’ decision to step back from Open Choice, the copyright of the article changed on 10th February 2020 to © Springer Nature Switzerland AG 2020 and the article is forthwith distributed under the terms of copyright. The original version of this article was revised.

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Javaherforoosh zadeh, F., Azemati, S. Adjusted tight control blood glucose management in diabetic patients undergoing on pump coronary artery bypass graft. A randomized clinical trial. J Diabetes Metab Disord 19, 423–430 (2020). https://doi.org/10.1007/s40200-020-00494-4

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Keywords

  • Cardiac surgery
  • Diabetes
  • Tight control of glucose
  • Critically ill patient