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Multidisciplinary intervention for control of diabetes in patients undergoing coronary artery bypass graft (CABG)
Ohad Cohen1, Rachel Dankner, Angela Chetrit
1Institute of Endocrinology, Sheba Medical Center, Tel-Hashomer, Israel. ohdcohen@sheba.health.gov.il
Insights
Achieving target blood glucose control in diabetic patients undergoing coronary artery bypass graft (CABG) surgery is challenging. This preliminary study found that strict metabolic goals for diabetes management were infrequently met during the perioperative period.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Background:
- Diabetes mellitus is highly prevalent in patients undergoing coronary artery bypass graft (CABG) surgery.
- Previous studies on the impact of diabetes control on CABG outcomes have yielded conflicting results.
- A prospective investigation is needed to clarify the relationship between diabetes management and CABG complications.
Purpose of the Study:
- To assess the feasibility of achieving specific metabolic goals for diabetes control in patients hospitalized for elective CABG.
- To evaluate diabetes management during the pre-operative, intra-operative, and post-operative periods.
- To identify potential correlations between glucose control and CABG-related complications.
Main Methods:
- A preliminary study of 147 consecutive diabetic patients undergoing elective CABG.
- Monitoring of fasting blood glucose (FBG) and postprandial blood glucose (PPBG) levels against defined metabolic goals.
- Assessment of complications, including deep sternal wound infection.
- Analysis of FBG and hemoglobin A1c (HbA1c) in patients with and without complications.
Main Results:
- Metabolic goals for FBG (65-140 mg/dl pre/post-op, 120-180 mg/dl intra-op) were achieved in 18.1% of measurements.
- Goals for PPBG (<180 mg/dl) were achieved in 22.1% (preprandial) and 14.6% (postprandial) of measurements.
- No clinical hypoglycemia occurred. Higher mean FBG and HbA1c levels were observed in patients with complications (P=0.01).
Conclusions:
- Achieving strict glycemic control in diabetic patients undergoing CABG is difficult within the perioperative timeframe.
- While major infection rates were low, elevated glucose levels may be associated with increased complications.
- Further prospective studies are warranted to confirm these findings and optimize diabetes management strategies in this high-risk population.
Abstract:
In Israel, as elsewhere, diabetes mellitus is highly prevalent among patients undergoing coronary artery bypass graft (CABG). The bulk of evidence, derived retrospectively, suggests that poor control of diabetes predisposes to complications of CABG and increases mortality; but the findings in a number of studies fail to support that impression. Anticipating a prospective investigation designed to resolve this issue, we have carried out a preliminary study of 147 consecutive patients with diabetes who were hospitalized for elective CABG during 1998. Our objective was to determine how well and how often diabetes could be controlled in accordance with selected metabolic goals in the brief interval between hospital admission and surgery and during the operation itself and in the postoperative period. The task was undertaken by a multidisciplinary team, in cooperation with the Department of Cardiac Surgery. The metabolic goals were: fasting blood glucose consistently between 65-140 mg/dl before and after surgery and 120-180 mg/dl at the time of surgery; and postprandial blood glucose consistently <180 mg/dl. These goals were achieved in 18.1% of fasting blood glucose measurements before and after surgery, 22.1% of preprandial and 14.6% of postprandial blood glucose levels consistently <180 mg/dl. There were no clinical episodes of hypoglycemia. Due to the low incidence of major infection related complications (deep sternal wound infection in only 3 patients (2.0%)) no significant statistical conclusions on the relations between glucose control and these complications could be drawn. The means of all values of FBG and of hemoglobin A1c were significantly higher among patients with complications (n=49) than in those without (P=0.01).
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