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Prospective evaluation of glucose metabolism in patients undergoing coronary artery bypass grafting
Krzysztof Greberski1, Przemysław Guzik, Henryk Wysocki
1Oddział Kardiochirurgii, Szpital im. J. Strusia, ul. Szkolna 8/12, 61-833 Poznań. kgreberski@poczta.onet.pl
Insights
Over 70% of patients undergoing coronary artery bypass grafting (CABG) have undiagnosed glucose metabolism disturbances. Early screening for these conditions is crucial for better patient outcomes.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Disorders
Background:
- Glucose metabolism disturbances are linked to increased risk of ischemic heart disease (IHD).
- Undiagnosed IHD complications often precede the identification of glucose metabolism issues.
- Previous evaluations of glucose metabolism disorders in patients undergoing CABG are limited.
Purpose of the Study:
- To assess the prevalence of glucose balance disturbances in patients with stable IHD undergoing elective coronary artery bypass grafting (CABG).
Main Methods:
- Prospective analysis of glucose metabolism in 117 consecutive IHD patients (under 80 years) scheduled for elective CABG.
- Included history assessment, physical examination, biochemical studies, echocardiography.
- Oral glucose tolerance tests (OGTT) were performed on patients without a prior diabetes mellitus diagnosis.
Main Results:
- Pre-existing glucose disturbances identified in 35% of patients (28.2% diabetes, 1.7% impaired glucose tolerance).
- OGTT revealed new diagnoses in 41.1% of previously undiagnosed patients (3.4% abnormal fasting glucose, 27.4% impaired glucose tolerance, 10.3% diabetes).
- Only 29.1% of patients had normal glucose balance.
Conclusions:
- Over 70% of patients undergoing elective CABG exhibit undiagnosed carbohydrate metabolism disturbances.
- Mandatory assessment of glucose regulation is recommended for all patients undergoing elective CABG surgery.
Introduction:
Disturbances of glucose metabolism are associated with increased risk of ischaemic heart disease (IHD). It is not uncommon that IHD and its complications precede diagnosis of glucose metabolism disturbances. Since publication of the American Diabetes Association's 2004 Guidelines for the assessment of glucose metabolism, no prospective evaluation of prevalence of carbohydrate metabolism disorders in patients referred for coronary artery bypass grafting (CABG) has been performed.
Aim:
Evaluation of prevalence of glucose balance disturbances in consecutive patients with stable IHD who underwent elective CABG procedures.
Methods:
Prospective analysis of glucose metabolism was carried out on a group of 117 consecutive IHD patients (including 31 women) aged below 80 years, selected for elective CABG surgery. In all patients, history assessment and physical examination as well as basic biochemical studies and resting echocardiography were performed. Additionally, in all individuals without previous diagnosis of diabetes mellitus, oral glucose tolerance test (OGTT) was carried out.
Results:
History analysis revealed glucose balance disturbances in 35 (29.9%) patients, including diabetes mellitus in 33 (28.2%) subjects and impaired glucose tolerance in 2 (1.7%) individuals. Based on OGTT results, among the remaining 82 (70.1%) subjects without previously known glucose metabolism disturbances 4 (3.4%) patients had abnormal fasting glycaemia, 32 (27.4%) subjects had impaired glucose tolerance, and diabetes mellitus was diagnosed in 12 (10.3%) individuals. No impaired glucose balance was found in only 34 (29.1%) examined subjects.
Conclusions:
Over 70% of all patients undergoing elective CABG procedure presented various forms of carbohydrate metabolism disturbances that were not diagnosed previously. Thus, it seems that the assessment of glucose regulation should be mandatory in all patients undergoing elective CABG surgery.
