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Glucose-insulin-potassium solutions improve outcomes in diabetics who have coronary artery operations
H L Lazar1, S Chipkin, G Philippides
1Department of Cardiothoracic Surgery, Boston Medical Center and Boston University School of Medicine, Massachusetts 02118, USA.
Insights
Glucose-insulin-potassium (GIK) therapy improved heart function and reduced complications in diabetic patients undergoing coronary artery bypass grafting (CABG). GIK treatment led to faster recovery and shorter hospital stays for these patients.
Area of Science:
- Cardiology
- Metabolic Medicine
- Surgical Outcomes
Background:
- Coronary artery bypass grafting (CABG) in diabetic patients presents unique challenges.
- Assessing interventions to improve myocardial performance and reduce morbidity post-CABG is critical.
Purpose of the Study:
- To investigate the efficacy of glucose-insulin-potassium (GIK) in enhancing myocardial performance.
- To determine if GIK administration limits postoperative morbidity in diabetic patients undergoing CABG.
Main Methods:
- A prospective randomized trial involving 40 diabetic patients undergoing CABG.
- Patients were assigned to receive either GIK infusion or standard care (no-GIK) for 12 hours postoperatively.
- GIK solution comprised D5W, regular insulin, and potassium chloride.
Main Results:
- The GIK group exhibited significantly higher postoperative cardiac indices (p < 0.0001) and lower inotrope scores (p = 0.05).
- GIK treatment resulted in less weight gain (p < 0.0001) and reduced duration of ventilator support (p = 0.0128).
- Patients receiving GIK had a lower incidence of atrial fibrillation (p = 0.003) and shorter hospital stays (p = 0.02).
Conclusions:
- Substrate enhancement with GIK significantly improves myocardial performance in diabetic patients post-CABG.
- GIK administration facilitates faster recovery and reduces complications, including atrial fibrillation and prolonged ventilation.
- This intervention offers a promising strategy for optimizing outcomes in diabetic patients undergoing cardiac surgery.
Background:
This study was undertaken to determine whether glucose-insulin-potassium (GIK) would improve myocardial performance and limit morbidity after coronary artery bypass grafting in diabetic patients.
Methods:
Forty consecutive coronary artery bypass grafting patients with medically treated diabetes mellitus were prospectively randomly assigned to either a GIK group (n = 20; 500 mL D5W + 80 U regular insulin + 40 mEq KCl 30 mL/hour) or a no-GIK group (n = 20; D5W at 30 mL/hour). The GIK was begun at anesthetic induction and continued for 12 hours postoperatively.
Results:
Patients treated with GIK had higher postoperative cardiac indices (2.88 +/- 0.50 versus 2.20 +/- 0.39 L/minute per square meter; p < 0.0001), lower inotrope scores (0.40 +/- 0.68 versus 1.25 +/- 1.44; p = 0.05), less weight gain (5.80 +/- 3.76 versus 13.85 +/- 6.52 pounds; p < 0.0001), and had shorter times of ventilator support (8.35 +/- 2.60 versus 13.45 +/- 7.33 hours; p = 0.0128). They had a significantly lower prevalence of atrial fibrillation (15% versus 60%; p = 0.003), and shorter hospital stays (6.70 +/- 1.52 versus 10.15 +/- 6.62 days; p = 0.02).
Conclusions:
Substrate enhancement with GIK in diabetic patients improved myocardial performance and resulted in faster recovery after coronary artery bypass grafting.