Effects of tight glucose control on the prognosis of patients after cardiac surgery: an overview of systematic reviews_Chinese Journal of Evidence-Based Medicine

Authors：

GAO Yan , LIU Huaxue ,  CHU Huamin

Department of Cardiac Surgery, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan 250021, P. R. China;

Corresponding?author：

CHU Huamin, Email: chuhuamin2008@163.com

Keywords：

Tight glucose control; Cardiac surgery; Perioperative period; Overview of systematic reviews

DOI：

10.7507/1672-2531.202507019

Video：

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Objective To systematically evaluate the effects of tight glucose control (TGC) on clinical outcomes in post-cardiac surgery patients through an overview of systematic reviews. Methods We conducted comprehensive searches in Web of Science, Cochrane Library, JBI, PubMed, Embase, CINAHL, CBM, CNKI, WanFang Data, and VIP databases from inception to June 11, 2025. Two researchers performed literature screening, data extraction, quality assessment of included studies, and evidence quality evaluation independently. The corrected covered area (CCA) was calculated to assess the overlap of primary studies across included SRs/MAs. Meta-analysis was performed by using RevMan 5.3 software. Results A total of 11 SRs/MAs were included. The CCA was 10.43%. The results demonstrated that TGC reduced postoperative infection rates (RR=0.46, 95%CI 0.36 to 0.58, P<0.001) early mortality (RR=0.67, 95%CI 0.51 to 0.87, 0.003), and postoperative atrial fibrillation (POAF) incidence (RR=0.69, 95%CI 0.59 to 0.80, P<0.001), while shortening hospital stays (MD=?1.65, 95%CI ?2.38 to ?0.92, P<0.001), ICU duration (MD=?3.18, 95%CI ?4.80 to ?1.56, P<0.001), and mechanical ventilation time (MD=?2.95, 95%CI ?4.36 to ?1.54, P<0.001). However, it also increased the risk of postoperative hypoglycemia (RR=2.22, 95%CI 1.18 to 4.21, 0.01). Subgroup analyses demonstrated that TGC significantly reduced the risk of POAF in patients undergoing coronary artery bypass grafting (CABG) (RR=0.60, 95%CI 0.48 to 0.75, P<0.001). Conversely, in valve replacement patients, TGC was associated with a significant shortening of both intensive care unit stay (MD=?5.37, 95%CI ?10.50 to ?0.23, P=0.04) and duration of mechanical ventilation (MD=?2.04, 95%CI ?3.39 to ?0.68, 0.003). Moreover, the increased risk of postoperative hypoglycemia was predominantly seen in CABG patients (RR=3.95, 95%CI 2.22 to 7.05, P<0.001) and those with diabetes mellitus (DM) (RR=3.42, 95%CI 1.45 to 8.07, 0.005). Conclusion While TGC improved postoperative outcomes in cardiac surgery patients, its effects were heterogeneous across surgical types and patient cohorts, and it elevated the risk of hypoglycemia, particularly among CABG and DM patients. Due to constraints in evidence quality, further robust, large-scale studies are needed to confirm these findings.

Citation： GAO Yan, LIU Huaxue, CHU Huamin. Effects of tight glucose control on the prognosis of patients after cardiac surgery: an overview of systematic reviews. Chinese Journal of Evidence-Based Medicine, 2026, 26(4): 445-452. doi: 10.7507/1672-2531.202507019 Copy

1.	Navaratnarajah M, Rea R, Evans R, et al. Effect of glycaemic control on complications following cardiac surgery: literature review. J Cardiothorac Surg, 2018, 13(1): 10.
2.	Moorthy V, Sim MA, Liu W, et al. Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery: a prospective study. Medicine (Baltimore), 2019, 98(23): e15911.
3.	Thongsuk Y, Hwang NC. Perioperative glycemic management in cardiac surgery: a narrative review. J Cardiothorac Vasc Anesth, 2024, 38(1): 248-267.
4.	Bláha J, Mráz M, Kopecky P, et al. Perioperative tight glucose control reduces postoperative adverse events in nondiabetic cardiac surgery patients. J Clin Endocrinol Metab, 2015, 100(8): 3081-3089.
5.	Reyes-Umpierrez D, Davis G, Cardona S, et al. Inflammation and oxidative stress in cardiac surgery patients treated to intensive versus conservative glucose targets. J Clin Endocrinol Metab, 2017, 102(1): 309-315.
6.	Ingels C, Debaveye Y, Milants I, et al. Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life. Eur Heart J, 2006, 27(22): 2716-2724.
7.	Duncan AE, Sessler DI, Sato H, et al. Hyperinsulinemic normoglycemia during cardiac surgery reduces a composite of 30-day mortality and serious in-hospital complications: a randomized clinical trial. Anesthesiology, 2018, 128(6): 1125-1139.
8.	宋保華, 蔣平君, 王志紅. 心臟手術患者圍手術期嚴格控制血糖與常規控制血糖比較療效的Meta分析. 中國循證醫學雜志, 2012, 12(10): 1229-1234.
9.	潘斯斯, 梁貴友, 劉達興, 等. 嚴格控制高血糖對體外循環心臟手術非糖尿病患者預后影響的Meta分析. 臨床心血管病雜志, 2019, 35(2): 167-173.
10.	van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med, 2001, 345(19): 1359-1367.
11.	Griesdale DE, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ, 2009, 180(8): 821-827.
12.	劉烈華, 李延兵. 糖尿病低血糖的危害和應對. 實用糖尿病雜志, 2009, 5(6): 4-6.
13.	朱政, 胡雁, 周英鳳, 等. 推動證據向臨床轉化(五)證據臨床轉化研究中的文獻質量評價. 護士進修雜志, 2020, 35(11): 996-1000.
14.	Norton M, Kuller J, Metz T. Society for maternal-fetal medicine special statement: grading of recommendations assessment, development, and evaluation (GRADE) update. Am J obstet gynecol, 2021, 224(4): B24-B28.
15.	馬寧, 潘蓓, 鄧錫源, 等. 傘形評價中文獻重疊的評估及處理. 中國循證醫學雜志, 2024, 24(10): 1212-1218.
16.	Pieper D, Antoine SL, Mathes T, et al. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol, 2014, 67(4): 368-375.
17.	Cardiothoracic Interdisciplinary Research Network; Rogers LJ, Vaja R, Bleetman D, et al. Interventions to prevent surgical site infection in adults undergoing cardiac surgery. Cochrane database syst rev, 2024, (12): CD013332.
18.	Hweidi IM, Zytoo AM, Hayajneh AA. Tight glycaemic control and surgical site infections post cardiac surgery: a systematic review. J Wound Care, 2021, 30(Sup12): S22-S28.
19.	Jin X, Wang J, Ma Y, et al. Association between perioperative glycemic control strategy and mortality in patients with diabetes undergoing cardiac surgery: a systematic review and meta-analysis. Front Endocrinol (Lausanne), 2020, 11: 513073.
20.	Boreland L, Scott-Hudson M, Hetherington K, et al. The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: a systematic review. Heart Lung, 2015, 44(5): 430-440.
21.	Hua J, Chen G, Li H, et al. Intensive intraoperative insulin therapy versus conventional insulin therapy during cardiac surgery: a meta-analysis. J Cardiothorac Vasc Anesth, 2012, 26(5): 829-834.
22.	Haga KK, McClymont KL, Clarke S, et al. The effect of tight glycaemic control, during and after cardiac surgery, on patient mortality and morbidity: a systematic review and meta-analysis. J Cardiothorac Surg, 2011, 6: 3.
23.	曾慶東. 比較體外循環下心臟手術患者圍術期血糖嚴格控制與常規控制的Meta分析. 中國循環雜志, 2015, (z1): 82-82.
24.	馬龍, 吳昆, 安園園, 等. 圍手術期嚴格控制血糖對心臟手術患者預后的影響(Meta分析). 中國危重病急救醫學, 2012, 24(4): 201-206.
25.	殷嘉晟, 姜雷, 胡必杰, 等. 心臟手術圍術期嚴格控制血糖對預防手術部位感染的薈萃分析. 中華醫院感染學雜志, 2012, 22(12): 2539-2542.
26.	Lazzeri C, Bevilacqua S, Ciappi F, et al. Glucose metabolism in cardiovascular surgery. HSR Proc Intensive Care Cardiovasc Anesth, 2010, 2(1): 19-26.
27.	樓松, 李景文, 龍村. 心臟外科患者圍手術期高血糖的研究進展. 中國體外循環雜志, 2009, 7(4): 241-245, 256.
28.	NICE-SUGAR Study Investigators; Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med, 2009, 360(13): 1283-1297.
29.	Sim MA, Liu W, Chew STH, et al. Wider perioperative glycemic fluctuations increase risk of postoperative atrial fibrillation and ICU length of stay. PLoS One, 2018, 13(6): e0198533.
30.	Lazar HL, Chipkin SR, Fitzgerald CA, et al. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation, 2004, 109(12): 1497-1502.
31.	Ji Q, Ding W, Mei Y, et al. Protective effects of tight glucose control during cardiopulmonary bypass on myocardium in adult nondiabetic patients undergoing valve replacement. Can J Cardiol, 2014, 30(11): 1429-1435.
32.	Zheng R, Gu C, Wang Y, et al. Impacts of intensive insulin therapy in patients undergoing heart valve replacement. Heart Surg Forum, 2010, 13(5): E292-E298.
33.	Sun Y, Wen Z, Ren Y, et al. Perioperative tight glucose control regimens for preventing surgical site infections following cardiac surgery-a systematic review and meta analysis of randomized controlled trials. J Clin Anesth, 2026, 108: 112051.
34.	Abdelmalak BB, Lansang MC. Revisiting tight glycemic control in perioperative and critically ill patients: when one size may not fit all. J Clin Anesth, 2013, 25(6): 499-507.
35.	Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J, 2020, 41(2): 255-323.
36.	Umpierrez G, Cardona S, Pasquel F, et al. Randomized controlled trial of intensive versus conservative glucose control in patients undergoing coronary artery bypass graft surgery: GLUCO-CABG trial. Diabetes Care, 2015, 38(9): 1665-1672.
37.	Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care, 2009, 32(6): 1119-1131.

1. Navaratnarajah M, Rea R, Evans R, et al. Effect of glycaemic control on complications following cardiac surgery: literature review. J Cardiothorac Surg, 2018, 13(1): 10.
2. Moorthy V, Sim MA, Liu W, et al. Risk factors and impact of postoperative hyperglycemia in nondiabetic patients after cardiac surgery: a prospective study. Medicine (Baltimore), 2019, 98(23): e15911.
3. Thongsuk Y, Hwang NC. Perioperative glycemic management in cardiac surgery: a narrative review. J Cardiothorac Vasc Anesth, 2024, 38(1): 248-267.
4. Bláha J, Mráz M, Kopecky P, et al. Perioperative tight glucose control reduces postoperative adverse events in nondiabetic cardiac surgery patients. J Clin Endocrinol Metab, 2015, 100(8): 3081-3089.
5. Reyes-Umpierrez D, Davis G, Cardona S, et al. Inflammation and oxidative stress in cardiac surgery patients treated to intensive versus conservative glucose targets. J Clin Endocrinol Metab, 2017, 102(1): 309-315.
6. Ingels C, Debaveye Y, Milants I, et al. Strict blood glucose control with insulin during intensive care after cardiac surgery: impact on 4-years survival, dependency on medical care, and quality-of-life. Eur Heart J, 2006, 27(22): 2716-2724.
7. Duncan AE, Sessler DI, Sato H, et al. Hyperinsulinemic normoglycemia during cardiac surgery reduces a composite of 30-day mortality and serious in-hospital complications: a randomized clinical trial. Anesthesiology, 2018, 128(6): 1125-1139.
8. 宋保華, 蔣平君, 王志紅. 心臟手術患者圍手術期嚴格控制血糖與常規控制血糖比較療效的Meta分析. 中國循證醫學雜志, 2012, 12(10): 1229-1234.
9. 潘斯斯, 梁貴友, 劉達興, 等. 嚴格控制高血糖對體外循環心臟手術非糖尿病患者預后影響的Meta分析. 臨床心血管病雜志, 2019, 35(2): 167-173.
10. van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med, 2001, 345(19): 1359-1367.
11. Griesdale DE, de Souza RJ, van Dam RM, et al. Intensive insulin therapy and mortality among critically ill patients: a meta-analysis including NICE-SUGAR study data. CMAJ, 2009, 180(8): 821-827.
12. 劉烈華, 李延兵. 糖尿病低血糖的危害和應對. 實用糖尿病雜志, 2009, 5(6): 4-6.
13. 朱政, 胡雁, 周英鳳, 等. 推動證據向臨床轉化(五)證據臨床轉化研究中的文獻質量評價. 護士進修雜志, 2020, 35(11): 996-1000.
14. Norton M, Kuller J, Metz T. Society for maternal-fetal medicine special statement: grading of recommendations assessment, development, and evaluation (GRADE) update. Am J obstet gynecol, 2021, 224(4): B24-B28.
15. 馬寧, 潘蓓, 鄧錫源, 等. 傘形評價中文獻重疊的評估及處理. 中國循證醫學雜志, 2024, 24(10): 1212-1218.
16. Pieper D, Antoine SL, Mathes T, et al. Systematic review finds overlapping reviews were not mentioned in every other overview. J Clin Epidemiol, 2014, 67(4): 368-375.
17. Cardiothoracic Interdisciplinary Research Network; Rogers LJ, Vaja R, Bleetman D, et al. Interventions to prevent surgical site infection in adults undergoing cardiac surgery. Cochrane database syst rev, 2024, (12): CD013332.
18. Hweidi IM, Zytoo AM, Hayajneh AA. Tight glycaemic control and surgical site infections post cardiac surgery: a systematic review. J Wound Care, 2021, 30(Sup12): S22-S28.
19. Jin X, Wang J, Ma Y, et al. Association between perioperative glycemic control strategy and mortality in patients with diabetes undergoing cardiac surgery: a systematic review and meta-analysis. Front Endocrinol (Lausanne), 2020, 11: 513073.
20. Boreland L, Scott-Hudson M, Hetherington K, et al. The effectiveness of tight glycemic control on decreasing surgical site infections and readmission rates in adult patients with diabetes undergoing cardiac surgery: a systematic review. Heart Lung, 2015, 44(5): 430-440.
21. Hua J, Chen G, Li H, et al. Intensive intraoperative insulin therapy versus conventional insulin therapy during cardiac surgery: a meta-analysis. J Cardiothorac Vasc Anesth, 2012, 26(5): 829-834.
22. Haga KK, McClymont KL, Clarke S, et al. The effect of tight glycaemic control, during and after cardiac surgery, on patient mortality and morbidity: a systematic review and meta-analysis. J Cardiothorac Surg, 2011, 6: 3.
23. 曾慶東. 比較體外循環下心臟手術患者圍術期血糖嚴格控制與常規控制的Meta分析. 中國循環雜志, 2015, (z1): 82-82.
24. 馬龍, 吳昆, 安園園, 等. 圍手術期嚴格控制血糖對心臟手術患者預后的影響(Meta分析). 中國危重病急救醫學, 2012, 24(4): 201-206.
25. 殷嘉晟, 姜雷, 胡必杰, 等. 心臟手術圍術期嚴格控制血糖對預防手術部位感染的薈萃分析. 中華醫院感染學雜志, 2012, 22(12): 2539-2542.
26. Lazzeri C, Bevilacqua S, Ciappi F, et al. Glucose metabolism in cardiovascular surgery. HSR Proc Intensive Care Cardiovasc Anesth, 2010, 2(1): 19-26.
27. 樓松, 李景文, 龍村. 心臟外科患者圍手術期高血糖的研究進展. 中國體外循環雜志, 2009, 7(4): 241-245, 256.
28. NICE-SUGAR Study Investigators; Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med, 2009, 360(13): 1283-1297.
29. Sim MA, Liu W, Chew STH, et al. Wider perioperative glycemic fluctuations increase risk of postoperative atrial fibrillation and ICU length of stay. PLoS One, 2018, 13(6): e0198533.
30. Lazar HL, Chipkin SR, Fitzgerald CA, et al. Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events. Circulation, 2004, 109(12): 1497-1502.
31. Ji Q, Ding W, Mei Y, et al. Protective effects of tight glucose control during cardiopulmonary bypass on myocardium in adult nondiabetic patients undergoing valve replacement. Can J Cardiol, 2014, 30(11): 1429-1435.
32. Zheng R, Gu C, Wang Y, et al. Impacts of intensive insulin therapy in patients undergoing heart valve replacement. Heart Surg Forum, 2010, 13(5): E292-E298.
33. Sun Y, Wen Z, Ren Y, et al. Perioperative tight glucose control regimens for preventing surgical site infections following cardiac surgery-a systematic review and meta analysis of randomized controlled trials. J Clin Anesth, 2026, 108: 112051.
34. Abdelmalak BB, Lansang MC. Revisiting tight glycemic control in perioperative and critically ill patients: when one size may not fit all. J Clin Anesth, 2013, 25(6): 499-507.
35. Cosentino F, Grant PJ, Aboyans V, et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur Heart J, 2020, 41(2): 255-323.
36. Umpierrez G, Cardona S, Pasquel F, et al. Randomized controlled trial of intensive versus conservative glucose control in patients undergoing coronary artery bypass graft surgery: GLUCO-CABG trial. Diabetes Care, 2015, 38(9): 1665-1672.
37. Moghissi ES, Korytkowski MT, DiNardo M, et al. American Association of Clinical Endocrinologists and American Diabetes Association consensus statement on inpatient glycemic control. Diabetes Care, 2009, 32(6): 1119-1131.

Chinese Journal of Evidence-Based Medicine

Effects of tight glucose control on the prognosis of patients after cardiac surgery: an overview of systematic reviews

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