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Improved Cardiac Function and Glycemic Control in Elderly Diabetic Patients Through Structured Case Management After
Wei Zhai1, Huan Yu1, Yuanyuan Li1
1Department of Cardiovascular Surgery, The Second Hospital of Tianjin Medical University, Tianjin, China.
Summary
A structured, multidisciplinary case management program significantly improved cardiac function and glycemic control in elderly patients with coronary heart disease and diabetes mellitus undergoing off-pump coronary artery bypass grafting.
Area of Science:
- Cardiology
- Endocrinology
- Geriatrics
Background:
- Elderly patients with coronary heart disease (CHD) and diabetes mellitus (DM) undergoing off-pump coronary artery bypass grafting (CABG) face significant perioperative risks.
- These risks include glucose fluctuations and impaired recovery, necessitating targeted management strategies.
Purpose of the Study:
- To evaluate the impact of a structured, multidisciplinary case management model on cardiac function and glycemic control.
- To assess improvements in left ventricular ejection fraction (LVEF) and HbA1c levels in high-risk elderly patients.
Main Methods:
- A single-center randomized controlled trial involving 168 elderly patients (≥65 years) with CHD and type 2 DM scheduled for off-pump CABG.
- Patients were randomized to a control group (routine care) or an observation group receiving a 6-month multidisciplinary intervention (cardiac rehab, diet, psychological support, follow-up).
- Primary endpoint: 6-month LVEF; key secondary endpoint: HbA1c.
Main Results:
- The observation group showed significantly higher LVEF (mean difference: 6.2%, P<0.001) and lower HbA1c (mean difference: 1.3%, P<0.001) at 6 months.
- Significant improvements were observed in left ventricular diameters, lipid profile, 6-minute walk test distance, and quality of life scores (DSQL, ADL).
Conclusions:
- Structured, multidisciplinary case management is effective in improving cardiac function and metabolic control in elderly diabetic patients post-off-pump CABG.
- This model offers a validated approach for managing this high-risk patient population, enhancing functional capacity and quality of life.
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