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J Thorac Cardiovasc Surg 2003;125:985-987
© 2003 The American Association for Thoracic Surgery

Editorials

Glucose control during cardiac surgery: How sweet it is

From the Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, Dallas, Tex.

Received for publication Dec 3, 2002. Revisions requested Dec 9, 2002; revisions received Dec 16, 2002. Accepted for publication Jan 6, 2003. Address for reprints: Michael E. Jessen, MD, Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-8879 (E-mail: michael.Jessen@utsouthwestern.edu).

The first 300 words of the full text of this article appear below.

See related article on page 1007.

It has long been recognized that patients with diabetes pose a particular challenge to cardiologists and cardiovascular surgeons. Patients with diabetes have worse outcomes after acute myocardial infarction, ¹ have a more ominous outlook if congestive heart failure develops, and appear to be at increased risk for serious arrhythmias and sudden cardiac death. ² Compounding these problems is the fact that patients with diabetes may have more advanced, diffuse coronary disease, making interventional procedures or coronary artery bypass grafting (CABG) unattractive, or they may have end-organ renal or neurologic dysfunction that excludes them from other therapies, such as cardiac transplantation. Outcomes of patients with diabetes who undergo surgical revascularization have been shown to be inferior to those of their counterparts without diabetes. ³ Any strategy that could improve outcomes in this group of patients would be a welcome addition to our surgical armamentarium.

In this issue of the Journal, Furnary and colleagues ⁴ present a study of insulin management in patients who had undergone CABG. During a 15-year period, their management of glucose levels was altered from a protocol of intermittent subcutaneous insulin injections to one of continuous intravenous insulin infusion. Another important evolution was in the target serum glucose levels for these patients, a value that moved from 200 mg/dL to 100 mg/dL during the study interval. Associated with these changes in glucose and insulin management were significant improvements in outcomes. Operative mortality was significantly reduced, with the principal benefit accounted for by an improvement in cardiac-related mortality. Furnary and colleagues ⁴ theorize that the mechanism of this effect is related to improved glucose uptake and use by the heart, leading to a superior metabolic condition within the myocyte and subsequent improved postischemic cardiac performance.

The concept that glucose and insulin management are important in myocardial ischemia . . . [Full Text of this Article]

Related Article

Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting

Anthony P. Furnary, Guangqiang Gao, Gary L. Grunkemeier, YingXing Wu, Kathryn J. Zerr, Stephen O. Bookin, H. Storm Floten, and Albert Starr
J. Thorac. Cardiovasc. Surg. 2003 125: 1007-1021. [Abstract] [Full Text] [PDF]

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