Abstract
ObjectiveTo analyze association between different perioperative glycemic control strategies and postoperative outcomes in patients with diabetes undergoing cardiac surgery.MethodsMEDLINE, Cochrane Library, Web of Science, EMBASE, Wanfang Data, China National Knowledge Infrastructure (CNKI) and China Biology Medicine (CBM) databases were searched from inception to January 31, 2019. Two researchers independently screened the literature, extracted data, and evaluated the risk of bias of included studies, and consensus was reached by discussion with a third researcher.ResultsSix RCTs were included in the meta-analysis. We analyzed the effect of liberal (>180 mg/dl or 10.0 mmol/L), moderate (140–180 mg/dl or 7.8–10.0 mmol/L) and strict (<140 mg/dl or 7.8 mmol/L) glycemic control strategies in patients with diabetes undergoing cardiac surgery. The pooled results showed that strict glycemic control strategy was associated with a significant reduction in the risk of atrial fibrillation [OR = 0.48, 95%CI (0.32, 0.72), P < 0.001] and sternal wound infection [OR = 0.28, 95%CI (0.14, 0.54), P < 0.001], while there was no significant differences in postoperative mortality, stroke, and hypoglycemic episodes when compared with moderate control. In addition, there is no significant difference between moderate and liberal glycemic control strategies in postoperative mortality. However, moderate control was beneficial in reducing atrial fibrillation [OR = 0.28, 95%CI (0.13, 0.60), P = 0.001] compared with the liberal glycemic control strategy.ConclusionsThis meta-analysis showed when compared with moderate glycemic control strategy in patients with diabetes undergoing cardiac surgery, maintained strict glycemic control was associated with lower risk of atrial fibrillation and sternal wound infection. No benefit was found with liberal glycemic control strategy, so it could be a poor glycemic control strategy.
Highlights
In recent years, the prevalence of diabetes has increased dramatically worldwide
Based on the analysis of included studies, moderate quality of evidence indicated that the strict glycemic control strategy was associated with a significant reduction in atrial fibrillation and sternal wound infection, but very low to lowquality of evidence showed that there was no significant reduction in the incidence of mortality, stroke and hypoglycemic episodes
We considered the difference in the incidence of mortality was due to the fact that most of the studies we analyzed had mortality within 30 days after surgery, while their examination was performed in the ICU
Summary
The prevalence of diabetes has increased dramatically worldwide. According to the statistics released by the International Diabetes Federation (IDF), there were 425 million patients with diabetes worldwide up to 2017 [1]. In China, the overall prevalence of diabetes in adults is 11.6%, and the total number of patients ranks first in the world [2]. As the number of people with diabetes increased, so did the proportion of diabetics who need surgery. Diabetics are more likely to undergo certain surgeries than nondiabetics, and they have high morbidity and mortality rates when seriously deteriorated or ill [3]. Among all patients undergoing surgery, diabetes accounts for 5%, and this proportion can reach up to 10% in elderly patients [4]
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