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Published on: June 11, 2012
Clinical and hemodynamic outcome following coronary artery bypass surgery in diabetic patients using
Christiano da Silveira de Barcellos1, Orlando C B Wender, Paulo Cerati de Azambuja
1Hospital São Vicente de Paulo - Hospital Escola da Faculdade de Medicina da Universidade de Passo Fundo, Passo Fundo, RS. christiano@via-rs.net
Insights
Glucose-Insulin-Potassium (GIK) infusion did not improve hemodynamic performance in diabetic patients undergoing CABG surgery. However, GIK therapy did lead to better glucose control and reduced postoperative infections compared to standard insulin treatment.
Area of Science:
- Cardiology
- Endocrinology
- Surgical Research
Background:
- Coronary Artery Bypass Grafting (CABG) surgery in diabetic patients presents unique challenges.
- Maintaining hemodynamic stability and optimizing glycemic control are critical for reducing morbidity and mortality.
- Glucose-Insulin-Potassium (GIK) infusion is a potential therapeutic strategy for improving outcomes in cardiac surgery patients.
Purpose of the Study:
- To evaluate the efficacy of GIK infusion in improving hemodynamic performance in diabetic patients undergoing CABG.
- To assess the impact of GIK infusion on the need for inotropic agents and postoperative morbidity.
- To compare glycemic control and surgical complications between GIK infusion and subcutaneous insulin in this patient population.
Main Methods:
- A randomized controlled trial involving patients with type 2 diabetes mellitus undergoing CABG.
- Patients received either GIK infusion or subcutaneous insulin from anesthetic induction for 12 hours postoperatively.
- Primary outcome was cardiac index (CI); secondary outcomes included hemodynamic parameters, glycemic control, inotropic use, and postoperative morbidity over 30 days.
Main Results:
- No significant difference in cardiac index (CI) was observed between the GIK and control groups.
- The GIK group exhibited significantly lower blood glucose levels and a reduced incidence of hyperglycemia.
- Postoperative infectious complications were significantly less frequent in the GIK group compared to the control group.
Conclusions:
- GIK infusion did not improve hemodynamic performance (CI) or reduce inotropic agent use in diabetic patients undergoing CABG.
- GIK infusion effectively improved glycemic control and reduced the incidence of hyperglycemia.
- A notable reduction in postoperative infections was observed in the GIK group, suggesting a potential benefit in reducing surgical complications.
Objective:
This study was undertaken to determine whether GIK infusion improves hemodynamic performance by reducing the use of inotropic agents, as well as the morbidity of diabetic patients submitted to CABG.
Methods:
Patients with type 2 DM referred for CABG were randomized to receive GIK or subcutaneous insulin from anesthetic induction up to 12 hours postoperatively. The primary clinical outcome was the cardiac index (CI) and the secondary clinical outcomes were the remaining hemodynamic parameters; the use of inotropics and vasodilators, the glycemic control (maintenance of plasma glucose levels), and the postoperative morbidity. Hemodynamic and laboratory measurements were performed in the first 24 hours postoperatively, and the patients were followed up for 30 days to detect any surgery-related complications.
Results:
Twenty-four patients were randomly included in the study. IC did not show significant difference (mean cardiac index at 24 hours in both GIK group 3.49+/-0.94 and Control group 3.38+/-0.75; p=0.74). The GIK group revealed lower blood glucose levels in the infusion period (glucose at 12 hours GIK group 195.6+/-68.25 versus Control group 269.6+/-78.48; p=0.02), with a lower incidence of hyperglycemia in the GIK group, two (16%) against eight (64%) in the control group (RR 0.25; 95% CI 0.07-0.94; p=0.03). Postoperative infectious complications were less frequent in the GIK group than in Control group, three (25%) against 10 (80%), respectively (RR 0.30; 95% CI 0.11-0.83; p=0.01).
Conclusions:
Studies have proven that GIK improves hemodynamic performance of both patients with or without DM submitted to CABG, what was not confirmed in this study. The use of GIK neither improved the CI improvement nor reduced the use of inotropic drugs, but it provided better glucose control. Secondary clinical outcome, including postoperative infections, was more frequent in the control group.
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