Interaction between diabetes, stress hyperlactatemia, and stress hyperglycemia appears to impact mortality after cardiac surgery, researchers concluded after conducting a retrospective cohort study involving nearly 4,100 individuals. Investigators grouped participants who had cardiac surgery by diabetes and glucose-lowering medication history. They then looked at hyperglycemia, hypoglycemia, and the link between lactate and glucose levels. Among the results:

• ~One-fourth of patients without diabetes experienced hyperglycemia.
• Among patients with diabetes, 47% experienced hyperglycemia prior to treatment, 63% while on oral medications, and 74% while receiving insulin therapy.
• Hypoglycemia occurred in 6%, 9%, 9%, and 11%, respectively.
• Among patients without diabetes, peak lactate was 5.8 mmol/L in those with hyperglycemia, vs 3.3 mmol/L in those without.
• The levels also differed by hyperglycemic status in patients 1) with diabetes without prior drug treatment (4.8 and 3.4 mmol/L); 2) taking oral medications (3.8 and 2.9 mmol/L); and 3) receiving insulin (3.3 and 2.7 mmol/L).
• Increasing lactate levels were linked with higher mortality.
• Increasing glucose reduced this effect in people with diabetes.