Patients with type 2 diabetes undergoing coronary artery bypass graft surgery: predictors of outcomes.
Type 2 diabetic (T2DM) patients undergoing CABG have worse outcomes than non-diabetic patients, especially if insulin-treated. The purpose of this study was to determine if pre-hospital management of diabetes (including insulin) and risk factors affect outcomes.


METHODS
T2DM patients were recruited at time of CABG and followed 3 months. Variables were illness level factors: insulin treatment, risk factor management, heart disease measures; Predisposing Factors: demographics, health status (SF-36), Geriatric Depression Scale (GDS), Charlson Co-morbidity Index (CCI);


RESULTS
post-operative length of stay (PLOS), complications, re-hospitalisation.


RESULTS
317 T2DM patients (mean age 66, female 37%) had poor health status, met half the risk factor goals, and 27% had depressive symptoms. Mean PLOS was 7.4+/-5 days, 44% had complications, and 32% were re-hospitalised. Insulin-treated patients were at higher risk and had worse outcomes. Independent predictors of outcomes: CCI and measures of left ventricular function (all outcomes); risk factor management (complications); insulin treatment, GDS, age (PLOS); female sex, BMI, PLOS (re-hospitalisation).


CONCLUSIONS
Insulin treatment in T2DM patients indicates patients at high risk of poor outcomes. Intensive management and rehabilitation is needed to improve outcomes, and patients would benefit from optimal management of risk factors pre- and post-CABG.
Deaton
Christi
C
School of Nursing, Midwifery & Social Work, The University of Manchester, University Hospital of South Manchester NHS Foundation Trust, United Kingdom. mcdeaton@manchester.ac.uk
Thourani
Vinod
V
D000368:Aged; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000601:surgery*; D003863:Depression / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors
D007004:Hypoglycemic Agents; D007328:Insulin