• Jan Bláha, Miloš Mráz, Petr Kopecký, Martin Stříteský, Michal Lipš, Michal Matias, Jan Kunstýř, Michal Pořízka, Tomáš Kotulák, Ivana Kolníková, Barbara Šimanovská, Mykhaylo Zakharchenko, Jan Rulíšek, Robert Šachl, Jiří Anýž, Daniel Novák, Jaroslav Lindner, Roman Hovorka, Štěpán Svačina, and Martin Haluzík.
• Department of Anesthesia, Resuscitation and Intensive Medicine (J.B., P.K., M.S., M.L., M.Ma., J.K., M.P., T.K., I.K., B.S., M.Z., J.R., R.S.), Third Department of Medicine-Department of Endocrinology and Metabolism (M.Mr., S.S., M.H.), and Second Department of Surgery- Department of Cardiovascular Surgery (J.L.), General University Hospital, Charles University in Prague First Faculty of Medicine, 128 08 Prague 1, Czech Republic; Department of Cybernetics (J.A., D.N.), Faculty of Electrical Engineering, Czech Technical University, 121 35 Prague 2, Czech Republic; and Institute of Metabolic Science (R.H.), University of Cambridge, Cambridge CB2 3AD, United Kingdom.
• J. Clin. Endocrinol. Metab. 2015 Aug 1;100(8):3081-9.

ContextTight 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.ObjectiveThe purpose of this article was to compare the effects of perioperative vs postoperative initiation of TGC on postoperative adverse events in cardiac surgery patients.DesignThis was a single center, single-blind, parallel-group, randomized controlled trial.SettingsThe setting was an academic tertiary hospital.ParticipantsParticipants were 2383 hemodynamically stable patients undergoing major cardiac surgery with expected postoperative intensive care unit treatment for at least 2 consecutive days.InterventionIntensive insulin therapy was initiated perioperatively or postoperatively with a target glucose range of 4.4 to 6.1 mmol/L.Main Outcome MeasuresAdverse events from any cause during postoperative hospital stay were compared.ResultsIn the whole cohort, perioperatively initiated TGC markedly reduced the number of postoperative complications (23.2% vs 34.1%, 95% confidence interval [CI], 0.60-0.78) despite only minimal improvement in glucose control (blood glucose, 6.6 ± 0.7 vs 6.7 ± 0.8 mmol/L, P < .001; time in target range, 39.3% ± 13.7% vs 37.3% ± 13.8%, P < .001). The positive effects of TGC on postoperative complications were driven by nondiabetic subjects (21.3% vs 33.7%, 95% CI, 0.54-0.74; blood glucose 6.5 ± 0.6 vs 6.6 ± 0.8 mmol/L, not significant; time in target range, 40.8% ± 13.6% vs 39.7% ± 13.8%, not significant), whereas no significant effect was seen in diabetic patients (29.4% vs 35.1%, 95% CI, 0.66-1.06) despite significantly better glucose control in the perioperative group (blood glucose, 6.9 ± 1.0 vs 7.1 ± 0.8 mmol/L, P < .001; time in target range, 34.3% ± 12.7% vs 30.8% ± 11.5%, P < .001).ConclusionsPerioperative initiation of intensive insulin therapy during cardiac surgery reduces postoperative morbidity in nondiabetic patients while having a minimal effect in diabetic subjects.

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