As detailed else- the perioperative control of serum glucose (glucose goal, 125 200 mg/dL) has been shown to improve both short- outcomes after CABG in most stud- ies. However, an overly aggressive lowering of serum glucose during and after CABG surgery (glucose goal, 90 120 mg/ dL) may fail to improve clinical outcomes, mainly because of the adverse effects of hypoglycemic episodes, compared with more moderate glycemic control (glucose goal, 120 180 In a large observational study involving >4500 CABG patients, Bhamidipati et al277 noted that mortality and complication rates were lowest among diabetic patients who received moderate glycemic control with glucose levels of 127 to 179 mg/dL compared with those who were treated with tight ( 126 mg/dL) or liberal ( 180 mg/dL) insulin protocols. Patients with diabetes mellitus have less favorable long-term outcomes after CABG compared with nondiabetic patients.278 However, it is not well understood whether the diminished long-term survival and freedom from adverse cardiovascular events are attributable to a general progression of cardiovascu- lar disease seen in diabetic patients or if CABG patients with poorly controlled diabetes mellitus have specific characteris- tics that make them prone to diminished long-term survival. These factors may include decreased early graft patency, a more rapid progression of native vessel atherosclerosis, and a reduction in myocardial function. Vein graft patency has been reported in some studies to be diminished in patients with diabetes mellitus and the metabolic syndrome.279 This may relate to the association between type 2 diabetes mellitus and impaired endothelial function and intimal degeneration of saphenous vein grafts, changes that inversely correlate with the metabolic control of the diabetes mellitus.280 Interestingly, diabetes mellitus has much less effect on the properties of the internal mammary artery. 