Letter Regarding Article by Lazar et al, “Tight Glycemic Control in Diabetic Coronary Artery Bypass Graft Patients Improves Perioperative Outcomes and Decreases Recurrent Ischemic Events”
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To the Editor:
We read with great interest the study by Lazar et al1 reporting improved outcomes in patients with diabetes after CABG by tight perioperative glycemic control via glucose-insulin-potassium (GIK). Some aspects of this work deserve further comment.
The authors’ statement that patients in the no-GIK group received standard therapy is misleading. Withholding insulin treatment until the patients’ blood glucose exceeds 250 mg/dL and administering insulin subcutaneously during cardiac procedures does not constitute standard care. Furthermore, challenging patients with diabetes with intravenous glucose during cardiac surgery (a time of pronounced insulin resistance even in subjects without diabetes) without the metabolic support of insulin may be questioned.
The authors do not disclose whether they used medications that often are diluted in glucose-containing solutions such as antibiotics, vasopressors, and nitroglycerin, although this is crucial for interpreting studies on perioperative glucose control. It also remains unclear whether, when, and …