Heart, Lung and Circulation

Conventional Glycaemic Control May Not Be Beneficial in Diabetic Patients Following Cardiac Surgery

Published:September 22, 2022DOI:


      Stress hyperglycaemia is common following cardiac surgery. Its optimal management is uncertain and emerging literature suggests that flexible glycaemic control in diabetic patients may be preferable. This study aims to assess the relationship between maximal postoperative in-hospital blood glucose levels (BSL) and the morbidity and mortality outcomes of diabetic and non-diabetic cardiac surgery patients.


      A retrospective cohort analysis of all patients undergoing cardiac surgery at a tertiary single centre institution from 2015 to 2019 was undertaken. Early management and outcomes of hyperglycaemia following cardiac surgery were assessed via multivariable regression modelling. Follow-up was assessed to 1 year postoperatively.


      Consecutive non-diabetic patients (n=1,050) and diabetic patients (n=689) post cardiac surgery were included. Diabetics with peak BSL ≤13.9 mmol/L did not have an increased risk of morbidity or mortality compared to non-diabetics with peak BSL ≤10.0 mmol/L. In non-diabetics, stress hyperglycaemia with peak BSL >10.0 mmol/L was associated with overall wound complications (5.7% vs 8.8%, OR 1.64 [1.00–2.69], p=0.049) and postoperative pneumonia (2.7% vs 7.3%, OR 2.35 [1.26–4.38], p=0.007). Diabetic patients with postoperative peak BSL >13.9 mmol/L were at an increased risk of overall wound complication (7.4% vs 14.8%, OR 2.47 [1.46–4.16], p<0.001), graft harvest site infection (3.7% vs 11.8%, OR 3.75 [1.92–7.30], p<0.001), and wound-related readmission (3.1% vs 8.8%, OR 3.11 [1.49–6.47], p=0.002) when compared to diabetics with peak BSL ≤13.9 mmol/L.


      In non-diabetics, stress hyperglycaemia with peak BSL >10.0 mmol/L is associated with morbidity. In diabetic patients, hyperglycaemia with peak BSL ≤13.9 mmol/L was not associated with an increased risk of morbidity or mortality compared to non-diabetics with peak BSL ≤10.0 mmol/L. Further investigation of flexible glycaemic targets (target BSL ≤13.9 mmol/L) in diabetic patients is warranted.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Heart, Lung and Circulation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Schmeltz L.R.
        • DeSantis A.J.
        • Thiyagarajan V.
        • Schmidt K.
        • O'Shea-Mahler E.
        • Johnson D.
        • et al.
        Reduction of surgical mortality and morbidity in diabetic patients undergoing cardiac surgery with a combined intravenous and subcutaneous insulin glucose management strategy.
        Diabetes Care. 2007; 30: 823-828
        • McAlister F.A.
        • Man J.
        • Bistritz L.
        • Amad H.
        • Tandon P.
        Diabetes and coronary artery bypass surgery: an examination of perioperative glycemic control and outcomes.
        Diabetes Care. 2003; 26: 1518-1524
        • Moorthy V.
        • Sim M.A.
        • Liu W.
        • Chew S.T.H.
        • Ti L.K.
        Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery: a prospective study.
        Medicine (Baltimore). 2019; 98e15911
        • Doenst T.
        • Wijeysundera D.
        • Karkouti K.
        • Zechner C.
        • Maganti M.
        • Rao V.
        • et al.
        Hyperglycemia during cardiopulmonary bypass is an independent risk factor for mortality in patients undergoing cardiac surgery.
        J Thorac Cardiovasc Surg. 2005; 130: 1144
        • Jarvela K.M.
        • Khan N.K.
        • Loisa E.L.
        • Sutinen J.A.
        • Laurikka J.O.
        • Khan J.A.
        Hyperglycemic episodes are associated with postoperative infections after cardiac surgery.
        Scand J Surg. 2018; 107: 138-144
        • Van den Berghe G.
        Beyond diabetes: saving lives with insulin in the ICU.
        Int J Obes Relat Metab Disord. 2002; 26: S3-S8
        • Brunkhorst F.M.
        • Engel C.
        • Bloos F.
        • Meier-Hellmann A.
        • Ragaller M.
        • Weiler N.
        • et al.
        Intensive insulin therapy and pentastarch resuscitation in severe sepsis.
        N Engl J Med. 2008; 358: 125-139
        • Preiser J.C.
        • Devos P.
        • Ruiz-Santana S.
        • Melot C.
        • Annane D.
        • Groeneveld J.
        • et al.
        A prospective randomised multi-centre controlled trial on tight glucose control by intensive insulin therapy in adult intensive care units: the Glucontrol study.
        Intensive Care Med. 2009; 35: 1738-1748
        • Investigators N.-S.S.
        • Finfer S.
        • Chittock D.R.
        • Su S.Y.
        • Blair D.
        • Foster D.
        • et al.
        Intensive versus conventional glucose control in critically ill patients.
        N Engl J Med. 2009; 360: 1283-1297
        • Umpierrez G.
        • Cardona S.
        • Pasquel F.
        • Jacobs S.
        • Peng L.
        • Unigwe M.
        • et al.
        Randomized Controlled Trial of Intensive Versus Conservative Glucose Control in Patients Undergoing Coronary Artery Bypass Graft Surgery: GLUCO-CABG Trial.
        Diabetes Care. 2015; 38: 1665-1672
        • Lazar H.L.
        • McDonnell M.
        • Chipkin S.R.
        • Furnary A.P.
        • Engelman R.M.
        • Sadhu A.R.
        • et al.
        The Society of Thoracic Surgeons practice guideline series: blood glucose management during adult cardiac surgery.
        Ann Thorac Surg. 2009; 87: 663-669
        • Marik P.E.
        • Bellomo R.
        Stress hyperglycemia: an essential survival response.
        Crit Care. 2013; 17: 305
        • Plummer M.P.
        • Bellomo R.
        • Cousins C.E.
        • Annink C.E.
        • Sundararajan K.
        • Reddi B.A.
        • et al.
        Dysglycaemia in the critically ill and the interaction of chronic and acute glycaemia with mortality.
        Intensive Care Med. 2014; 40: 973-980
        • Krinsley J.S.
        • Egi M.
        • Kiss A.
        • Devendra A.N.
        • Schuetz P.
        • Maurer P.M.
        • et al.
        Diabetic status and the relation of the three domains of glycemic control to mortality in critically ill patients: an international multicenter cohort study.
        Crit Care. 2013; 17: R37
        • Egi M.
        • Bellomo R.
        • Stachowski E.
        • French C.J.
        • Hart G.
        Variability of blood glucose concentration and short-term mortality in critically ill patients.
        Anesthesiology. 2006; 105: 244-252
        • Marik P.E.
        • Egi M.
        Treatment thresholds for hyperglycemia in critically ill patients with and without diabetes.
        Intensive Care Med. 2014; 40: 1049-1051
        • Greco G.
        • Ferket B.S.
        • D'Alessandro D.A.
        • Shi W.
        • Horvath K.A.
        • Rosen A.
        • et al.
        Diabetes and the association of postoperative hyperglycemia with clinical and economic outcomes in cardiac surgery.
        Diabetes Care. 2016; 39: 408-417
        • Rau C.S.
        • Wu S.C.
        • Chen Y.C.
        • Chien P.C.
        • Hsieh H.Y.
        • Kuo P.J.
        • et al.
        Stress-Induced hyperglycemia in diabetes: a cross-sectional analysis to explore the definition based on the Trauma Registry Data.
        Int J Environ Res Public Health. 2017; 14
        • Hu H.
        • Hori A.
        • Nishiura C.
        • Sasaki N.
        • Okazaki H.
        • Nakagawa T.
        • et al.
        Hba1c, Blood pressure, and lipid control in people with diabetes: Japan Epidemiology Collaboration on Occupational Health Study.
        PLoS One. 2016; 11e0159071
        • Dungan K.M.
        • Braithwaite S.S.
        • Preiser J.C.
        Stress hyperglycaemia.
        Lancet. 2009; 373: 1798-1807
        • Lang C.H.
        • Dobrescu C.
        Gram-negative infection increases noninsulin-mediated glucose disposal.
        Endocrinology. 1991; 128: 645-653
        • Oddo M.
        • Schmidt J.M.
        • Carrera E.
        • Badjatia N.
        • Connolly E.S.
        • Presciutti M.
        • et al.
        Impact of tight glycemic control on cerebral glucose metabolism after severe brain injury: a microdialysis study.
        Crit Care Med. 2008; 36: 3233-3238
        • Saisho Y.
        Glycemic variability and oxidative stress: a link between diabetes and cardiovascular disease?.
        Int J Mol Sci. 2014; 15: 18381-18406