Liberal glucose control proves effective in reducing CABG mortality

In coronary artery bypass surgery (CABG), glucose control has shown to be important for survival. One research team, however, has questioned whether a strict or liberal glucose strategy was as effective or superior for improving survival.

Following up on prior research, the team from Inova Heart and Vascular Institute led by A. Thomas Pezzella, MD, compared data on strict glycemic control with a liberal protocol. The researchers found that patients treated with this strategy following coronary surgery survived as well as patients with a stricter regimen. Pezzella et al published their findings in the October issue of Annals of Thoracic Surgery.

Strict glycemic control was considered to be between 90 to 120 mg per dL. Liberal control was defined as being between 121 and 180 mg per dL.

They found that strict glycemic control was harder to maintain than liberal control. They also found that there were no differences in cumulative survival between those patients who had been strictly controlled and those who had been allowed a more liberal range, 95.5 percent vs 93.3 percent. No differences were noted between patient groups in reported health-related quality of life.

Pezzella et al did note that some data was outside of the scope of this research including detailed information about follow-up events beyond mortality. However, they did note 30-day readmissions appeared to have fewer (4 percent vs. 9 percent), but the researchers did not consider the difference to be significant.

Harold Lazar, MD, of Boston Medical Center commented that future research should address the question of whether or not a difference was seen in cardiac-related issues between the two glycemic control groups and intends to set sights in that direction next.

While further cardiac related issues were not part of the scope of the research of Pezzella et al, within the scope of mortality and quality of life, both were determined to be equally safe and effective for use in those centers with computerized glucose management.