Perioperative Tight Glucose Control Reduces Postoperative Adverse Events in Nondiabetic Cardiac Surgery Patients

Context: Tight glucose control (TGC) reduces morbidity and mortality in patients undergoing elective cardiac surgery, but only limited data about its optimal timing are available to date. Objective: The purpose of this article was to compare the effects of perioperative vs postoperative initiation of TGC on postoperative adverse events in cardiac surgery patients. Design: This was a single center, single-blind, parallel-group, randomized controlled trial. Settings: The setting was an academic tertiary hospital. Participants: Participants were 2383 hemodynamically stable patients undergoing major cardiac surgery with expected postoperative intensive care unit treatment for at least 2 consecutive days. Intervention: Intensive insulin therapy was initiated perioperatively or postoperatively with a target glucose range of 4.4 to 6.1 mmol/L. Main Outcome Measures: Adverse events from any cause during postoperative hospital stay were compared. Results: In the whole cohort, perioperatively initiated TGC markedly...