Why the study?
Does intensive insulin therapy reduce mortality and morbidity in cardiac surgery patients?
Does intensive insulin therapy reduce mortality and morbidity in cardiac surgery patients?
Intensive insulin therapy targeting 80-120 mg/dl does not improve perioperative outcomes compared to liberal glycemic strategies in cardiac surgery patients and should not replace conventional therapy as the standard of care.
Answers are grounded in this paper and cite their sources.
Intensive insulin offers no perioperative benefit over liberal control in cardiac surgery; reinforces liberal targets as standard of care.
Introduction: Optimal glycemic control in cardiac surgery patients remains a laudable but confusing practice. Existing studies have primarily employed two maintenance strategies using either intensive insulin therapy (IIT) (maintain glucose p = 0.628), ICU LOS (MD = -0.073 days, 95% CI = -0.324 to 0.178; p = 0.568), or hospital LOS (MD = 0.269, 95% CI = -2.158 to 2.696; p = 0.828). No difference in AF rates (RR = 0.887, 95% CI = 0.681 to 1.155; p = 0.375) or deep sternal infection (RR = 0.985, 95% CI = 0.357 to 2.720; p = 0.977) were observed. Conclusion: IIT targeting blood sugar levels of 80 - 120 mg/dl have no effect on perioperative outcomes in cardiac surgery patients. IIT is associated with similar mortality, ICU LOS, hospital LOS, AF rates, and deep sternal infection rates compared to more liberal glycemic strategies. IIT should not replace CIT as the standard of care in cardiac surgery patients.
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Kulkarni et al. (2016) studied this question.
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