Clinical and hemodynamic outcome following coronary artery bypass surgery in diabetic patients using glucose-insulin-potassium (GIK) solution: a randomized clinical trial.
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.
D000704:Analysis of Variance; D001786:Blood Glucose / Q000502:physiology; D002316:Cardiotonic Agents / Q000008:administration & dosage / Q000032:analysis; D001026:Coronary Artery Bypass; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology*; D005260:Female; D005947:Glucose / Q000008:administration & dosage / Q000009:adverse effects; D006439:Hemodynamics / Q000187:drug effects* / Q000502:physiology; D006801:Humans; D007328:Insulin / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011188:Potassium / Q000008:administration & dosage / Q000009:adverse effects; D018709:Statistics, Nonparametric
D001786:Blood Glucose; D002316:Cardiotonic Agents; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium