PMID- 36788548 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230217 IS - 1758-5996 (Print) IS - 1758-5996 (Electronic) IS - 1758-5996 (Linking) VI - 15 IP - 1 DP - 2023 Feb 14 TI - Effect of glycemic control and glucose fluctuation on in-hospital adverse outcomes after on-pump coronary artery bypass grafting in patients with diabetes: a retrospective study. PG - 20 LID - 10.1186/s13098-023-00984-4 [doi] LID - 20 AB - BACKGROUND: The optimal glycemic control level in diabetic patients undergoing coronary artery bypass grafting (CABG) with cardiopulmonary bypass (On-Pump) remains unclear. Therefore, this study aimed to investigate the effect of different blood glucose control levels and glucose fluctuations on in-hospital adverse outcomes in diabetic patients undergoing on-pump CABG. METHOD: A total of 3918 patients with diabetes undergoing CABG were reviewed in this study. A total of 1638 patients were eligible for inclusion and were categorized into strict, moderate and liberal glucose control groups based on post-operative mean blood glucose control levels of < 7.8 mmol/L, from 7.8 to 9.9 mmol/L and >/= 10.0 mmoL/L, respectively. The primary endpoint was defined as a composite endpoint including in-hospital all-cause mortality and major cardiovascular complications. The secondary endpoint was defined as major cardiovascular complications including acute myocardial infarction, strokes and acute kidney injuries. To determine the associations between blood glucose fluctuations and adverse outcomes, patients with different glycemic control levels were further divided into subgroups according to whether the largest amplitude of glycemic excursion (LAGE) was >/= 4.4 mmol/L or not. RESULTS: A total of 126 (7.7%) patients had a composite endpoint. Compared with moderate control, strict glucose control was associated with an increased risk of the primary endpoint (adjusted OR = 2.22, 95% CI 1.18-4.15, p = 0.01) and the secondary endpoint (adjusted OR = 1.95, 95% CI 1.01-3.77, p = 0.049). Furthermore, LAGE >/= 4.4 mmol/L was significantly associated with the primary endpoint (adjusted OR = 1.67, 95% CI 1.12-2.50, p = 0.01) and the secondary endpoint (adjusted OR = 1.75, 95% CI 1.17-2.62, p = 0.01),respectively. Patients with LAGE >/= 4.4 mmol/L had significantly higher rates of the composite endpoint and major vascular complications in both the strict-control (the primary endpoint, 66.7% vs 12.4%, p = 0.034, the secondary endpoint, 66.7% vs 10.3%, p = 0.03) and moderate-control groups (the primary endpoint, 10.2% vs 6.0%, p = 0.03, the secondary endpoint, 10.2% vs 5.8%, p = 0.02). CONCLUSIONS: After On-Pump CABG patients with diabetes, strict glucose control (< 7.8 mmol/L) and relatively large glucose fluctuations (LAGE >/= 4.4 mmol/L) were independently associated with in-hospital adverse outcomes. CI - (c) 2023. The Author(s). FAU - You, Hongzhao AU - You H AD - Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China. FAU - Hou, Xiaopei AU - Hou X AD - Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China. FAU - Zhang, Heng AU - Zhang H AD - Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Li, Xiaojue AU - Li X AD - Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China. FAU - Feng, Xinxing AU - Feng X AD - Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China. FAU - Qian, Xin AU - Qian X AD - Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China. FAU - Shi, Na AU - Shi N AD - Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China. FAU - Guo, Rong AU - Guo R AD - Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China. FAU - Wang, Xuan AU - Wang X AD - Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China. FAU - Sun, Hansong AU - Sun H AD - Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Feng, Wei AU - Feng W AD - Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. FAU - Li, Guangwei AU - Li G AD - Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China. FAU - Zheng, Zhe AU - Zheng Z AD - Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China. zhengzhe@fuwai.com. FAU - Chen, Yanyan AU - Chen Y AD - Endocrinology Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, No.167 North Lishi Road, Xicheng District, Beijing, 100037, China. dryanyanchen@126.com. LA - eng GR - 2022-FWQN08/The Project for The Distinguishing Academic Discipline of Fuwai Hospital/ GR - NCRC2020004/The National Clinical Research Center of Cardiovascular Diseases/ PT - Journal Article DEP - 20230214 PL - England TA - Diabetol Metab Syndr JT - Diabetology & metabolic syndrome JID - 101488958 PMC - PMC9930270 OTO - NOTNLM OT - Adverse outcome OT - Blood glucose fluctuation OT - Cardiopulmonary bypass OT - Coronary artery bypass grafting OT - Diabetes COIS- All patients have no competing interest to disclose. EDAT- 2023/02/16 06:00 MHDA- 2023/02/16 06:01 PMCR- 2023/02/14 CRDT- 2023/02/15 00:26 PHST- 2023/01/03 00:00 [received] PHST- 2023/01/20 00:00 [accepted] PHST- 2023/02/15 00:26 [entrez] PHST- 2023/02/16 06:00 [pubmed] PHST- 2023/02/16 06:01 [medline] PHST- 2023/02/14 00:00 [pmc-release] AID - 10.1186/s13098-023-00984-4 [pii] AID - 984 [pii] AID - 10.1186/s13098-023-00984-4 [doi] PST - epublish SO - Diabetol Metab Syndr. 2023 Feb 14;15(1):20. doi: 10.1186/s13098-023-00984-4.