Intraoperative Intensive Insulin Therapy Did Not Improve Outcomes Among Patients Undergoing Cardiac Surgery

Design. Randomized, controlled trial at a single academic teaching hospital. subjects. Four hundred patients undergoing on-pump cardiac surgery. Mean age was 63 years, 69% were men, 96% were white, and 20% had a history of diabetes. Methods. Patients were assigned randomly to receive either conventional intraoperative glucose control (treatment for blood glucose > 200 mg/dl) or intensive control (insulin infusion to maintain blood glucose between 80 and 100 mg/dl). After surgery, both groups were treated with intensive glucose control. The main outcome was the combined incidence of death, sternal infection, prolonged mechanical ventilation, arrhythmia, stroke, or renal failure within 30 days. Results. Intensive therapy lowered mean blood glucose: 114 mg/dl in the intensive group versus 157 mg/dl in the conventional group at the end of surgery. However, no difference was observed in the incidence of the main composite outcome; 44% of patients in the intensive group had an event versus 46% in the conventional group (risk ratio 1.0; 95% confidence interval 0.8, 1.2). Deaths (4 vs. 0) and strokes (8 vs. 1) were more common in the intensive treatment group. Outcomes appeared similar for patients with and without previously diagnosed diabetes. conclusions. Intensive intraoperative insulin therapy did not confer additional benefit compared with conventional intraoperative management in patients undergoing cardiac surgery.