Tehran University of Medical Sciences Archives of Anesthesiology and Critical Care 2423-5849 0 0 2025 12 02 1343 1343 EN Raheleh Ganjali Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Mahdi Kahrom Department of Cardiovascular Surgery, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Fatemeh Bijari Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Masoomeh Tabari Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. Ali Firoozjah Department of Cardiac Intensive Care, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran. Shima Sheybani Department of Anesthesiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran. 2025 07 14 2025 08 11 Background: Diabetes mellitus in subjects of coronary artery bypass grafting (CABG) surgery is associated with increased morbidity and mortality. Therefore, in recent years, glycemic monitoring and control have been the focus of clinical research. This study aimed to determine the impact of insulin glargine on the management of blood glucose during the perioperative period of on-pump coronary artery bypass graft in diabetic patients. Methods: In a randomized clinical trial, 80 patients with type 2 diabetes, candidates for elective CABG with a cardiopulmonary pump, were randomly separated into two groups. The intervention group received 0.2 units/kg of insulin glargine 2 hours before induction of anesthesia plus usual care. The control group received usual care. Usual care included injection of regular insulin before, during, and after surgery in accordance with a changed Van den Berghe code. Blood glucose (BG) level, ICU and hospital length of stay (LOS), creatinine, white blood cell count (WBC), and postoperative complications, including infection and dehiscence, were evaluated between two groups. Results: The BG of patients upon entrance (p=0.04), 16 (p=0.01), 20 (p=0.01), and 24 (p=0.01) hours after admission to the ICU was significantly lower in the intervention than in the control group. There was a significant difference in the average BG levels at different times (p<0.001), so the highest and lowest BG levels were observed 4 and 20 hours after ICU administration in the intervention group and 4 hours and immediately after ICU admission in the control group. Average creatinine (p=0.01), regular insulin used until the end of the first day after surgery (p=0.01), ICU length of stay (LOS) (p=0.009), and hospital LOS (p=0.001) were significantly lower in the intervention group than the controls. Conclusion: Insulin glargine plus regular insulin is able to maintain BG at a controlled level up to 24 hours after surgery. It also showed significant control over postoperative complications. This study revealed the therapeutic effectiveness of both insulin glargine and regular insulin in achieving adequate BG control for type 2 diabetes patients during the critical postoperative period of on-pump CABG. https://aacc.tums.ac.ir/index.php/aacc/article/view/1343