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.
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
Harold L
HL
Lazar
Stuart R
SR
Chipkin
Carmel A
CA
Fitzgerald
Yusheng
Y
Bao
Howard
H
Cabral
Carl S
CS
Apstein
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