Tight glycemic control in diabetic coronary artery bypass graft patients improves perioperative outcomes and decreases recurrent ischemic events.
BACKGROUND
This study sought to determine whether tight glycemic control with a modified glucose-insulin-potassium (GIK) solution in diabetic coronary artery bypass graft (CABG) patients would improve perioperative outcomes.


RESULTS
One hundred forty-one diabetic patients undergoing CABG were prospectively randomized to tight glycemic control (serum glucose, 125 to 200 mg/dL) with GIK or standard therapy (serum glucose <250 mg/dL) using intermittent subcutaneous insulin beginning before anesthesia and continuing for 12 hours after surgery. GIK patients had lower serum glucose levels (138+/-4 versus 260+/-6 mg/dL; P<0.0001), a lower incidence of atrial fibrillation (16.6% versus 42%; P=0.0017), and a shorter postoperative length of stay (6.5+/-0.1 versus 9.2+/-0.3 days; P=0.003). GIK patients also showed a survival advantage over the initial 2 years after surgery (P=0.04) and decreased episodes of recurrent ischemia (5% versus 19%; P=0.01) and developed fewer recurrent wound infections (1% versus 10%, P=0.03).


CONCLUSIONS
Tight glycemic control with GIK in diabetic CABG patients improves perioperative outcomes, enhances survival, and decreases the incidence of ischemic events and wound complications.
Lazar
Harold L
HL
Department of Cardiothoracic Surgery, Boston University School of Medicine and Boston Medical Center, 88 E Newton St, B402, Boston, Mass 02118, USA. harold.lazar@bmc.org
Chipkin
Stuart R
SR
Fitzgerald
Carmel A
CA
Bao
Yusheng
Y
Cabral
Howard
H
Apstein
Carl S
CS
D001281:Atrial Fibrillation / Q000517:prevention & control; D001786:Blood Glucose / Q000032:analysis*; D002314:Cardioplegic Solutions / Q000008:administration & dosage / Q000627:therapeutic use*; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D001026:Coronary Artery Bypass; D023921:Coronary Stenosis / Q000150:complications / Q000601:surgery; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000097:blood* / Q000188:drug therapy; D005230:Fatty Acids, Nonesterified / Q000097:blood; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007773:Lactates / Q000097:blood; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D011188:Potassium / Q000008:administration & dosage / Q000627:therapeutic use*; D012008:Recurrence; D013530:Surgical Wound Infection / Q000453:epidemiology; D016896:Treatment Outcome
D001786:Blood Glucose; D002314:Cardioplegic Solutions; D002316:Cardiotonic Agents; D005230:Fatty Acids, Nonesterified; D007328:Insulin; D007773:Lactates; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium