Does Tight Blood Glucose Control during Cardiac Surgery Improve Patient Outcome?
Authors: Greet Van den Berghe
Journal: Annals of Internal Medicine (2007)

Editorials20 February 2007Does Tight Blood Glucose Control during Cardiac Surgery Improve Patient Outcome?Greet Van den Berghe, MD, PhDGreet Van den Berghe, MD, PhDFrom Catholic University of Leuven, Leuven, Belgium.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-146-4-200702200-00012 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Intensive insulin therapy to maintain normal levels of blood glucose (4.4 to 6.1 mmol/L [80 to 110 mg/dL]) during intensive care improves survival and reduces morbidity of critically ill patients after complicated, high-risk, or extensive surgery or trauma (1). Clear benefit from this intervention requires maintenance of tight blood glucose control for at least a few days (2). The mechanism by which maintaining normoglycemia prevents adverse outcomes is not fully understood. One possibility is that avoiding sustained cellular glucose overload and toxicity in certain cell types reduces the likelihood for vital organ dysfunction (3). Avoiding glucose toxicity seems to prevent ...References1. Van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001;345:1359-67. [PMID: 11794168] CrossrefMedlineGoogle Scholar2. Van den Berghe G, Wilmer A, Milants I, Wouters PJ, Bouckaert B, Bruyninckx F, et al. Intensive insulin therapy in mixed medical/surgical intensive care units: benefit versus harm. Diabetes. 2006;55:3151-9. [PMID: 17065355] CrossrefMedlineGoogle Scholar3. Ellger B, Debaveye Y, Vanhorebeek I, Langouche L, Giulietti A, Van Etten E, et al. Survival benefits of intensive insulin therapy in critical illness: impact of maintaining normoglycemia versus glycemia-independent actions of insulin. Diabetes. 2006;55:1096-105. [PMID: 16567534] CrossrefMedlineGoogle Scholar4. Vanhorebeek I, De Vos R, Mesotten D, Wouters PJ, De Wolf-Peeters C, Van den Berghe G. Protection of hepatocyte mitochondrial ultrastructure and function by strict blood glucose control with insulin in critically ill patients. Lancet. 2005;365:53-9. [PMID: 15639679] CrossrefMedlineGoogle Scholar5. Ingels C, Debaveye Y, Milants I, Buelens E, Peeraer A, Devriendt Y, et al. Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life. Eur Heart J. 2006;27:2716-24. [PMID: 16608860] CrossrefMedlineGoogle Scholar6. Furnary AP, Gao G, Grunkemeier GL, Wu Y, Zerr KJ, Bookin SO, et al. Continuous insulin infusion reduces mortality in patients with diabetes undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2003;125:1007-21. [PMID: 12771873] CrossrefMedlineGoogle Scholar7. Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, O'Brien PC, et al. Intensive intraoperative insulin therapy versus conventional glucose management during cardiac surgery. A randomized trial. Ann Intern Med. 2007;146:233-43. LinkGoogle Scholar8. Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, Williams BA, et al. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc. 2005;80:862-6. [PMID: 16007890] CrossrefMedlineGoogle Scholar9. Furnary AP, Wu Y. Clinical effects of hyperglycemia in the cardiac surgery population: the portland diabetic project. Endocr Pract. 2006;12 Suppl 3 22-6. [PMID: 16905513] CrossrefMedlineGoogle Scholar10. Furnary AP, Wu Y. Eliminating the diabetes disadvantage: the Portland Diabetic Project. Semin Thorac Cardiovasc Surg. 2007; [In press]. Google Scholar Author, Article, and Disclosure InformationAffiliations: From Catholic University of Leuven, Leuven, Belgium.Disclosures: None disclosed.Corresponding Author: Greet Van den Berghe, MD, PhD, Catholic University of Leuven, Department of Intensive Care Medicine, University Hospital Gasthuisberg, B-3000 Leuven, Belgium; e-mail, greta.[email protected]kuleuven.be. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoIntensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery Gunjan Y. Gandhi , Gregory A. Nuttall , Martin D. Abel , Charles J. Mullany , Hartzell V. Schaff , Peter C. O'Brien , Matthew G. Johnson , Arthur R. Williams , Susanne M. Cutshall , Lisa M. Mundy , Robert A. Rizza , and M. 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