Ferran Rius, MD; Didac Mauricio, MD, PhD
Rius F., Mauricio D.; Intensive Intraoperative Insulin Therapy versus Conventional Glucose Management during Cardiac Surgery. Ann Intern Med. 2007;147:521. doi: 10.7326/0003-4819-147-7-200710020-00018
Download citation file:
Published: Ann Intern Med. 2007;147(7):521.
TO THE EDITOR:
The results of a nicely planned and performed randomized, controlled trial were recently published in the article by Gandhi and colleagues (1). The study has a relevant message for routine clinical practice, preventing clinicians from introducing tight blood glucose control during cardiac surgery. We agree with the main conclusions from the study about the lack of benefit of intensive insulin therapy during cardiac surgery, although it is not a surprising finding, as stated in the editorial by Van den Berghe (2).
As the editorialist pointed out (2), the increase in mortality is not significant and may be attributable to chance. Furthermore, the study was neither designed nor powered to answer such a question. However, when the data are carefully examined, concern arises about some differences in the baseline characteristics of the 2 study groups that may explain, at least in part, the occurrence of more deaths and strokes in the intervention group. The main difference is in the use of aspirin: 89 (48%) patients in the intensive treatment group versus 112 (60%) in the conventional treatment group. This difference is significant (P < 0.025) and may have some relationship with the different event rate detected. Furthermore, if taken together, some additional differences between the groups, although not statistically significant, may have a relevant influence on the outcome: More male patients were included in the intensive treatment group (134 vs. 123 patients), fewer received angiotensin-converting enzyme inhibitors (65 vs. 72 patients) and β-blockers (96 vs. 103 patients), and more had a history of cerebrovascular disease (20 vs. 13 patients). Among patients with diabetes, 20 (vs. 11 in the control group) were previously treated only with oral drugs. The heterogeneity in the baseline characteristics of the study groups is most likely due to a random effect, but we feel that this factor may explain an important part of the excess event rate reported in the intensive treatment group. We strongly believe that further clinical research on this important issue is warranted.
to gain full access to the content and tools.
Learn more about subscription options.
Register Now for a free account.
Copyright © 2016 American College of Physicians. All Rights Reserved.
Print ISSN: 0003-4819 | Online ISSN: 1539-3704
Conditions of Use
This PDF is available to Subscribers Only