Continuous Intravenous Insulin Infusion in Patients with Diabetes Mellitus After Coronary Artery Bypass Grafting: Impact on Glycemic Control Parameters and Postoperative Complications
Abstract
:1. Introduction
2. Methods
2.1. Study Population
2.2. Clinical Outcomes
2.3. Statistical Analysis
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Vrints, C.; Andreotti, F.; Koskinas, K.C.; Rossello, X.; Adamo, M.; Ainslie, J.; Banning, A.P.; Budaj, A.; Buechel, R.R.; Chiariello, G.A.; et al. 2024 ESC Guidelines for the management of chronic coronary syndromes. Eur. Heart J. 2024, 45, 3415–3537. [Google Scholar] [CrossRef] [PubMed]
- Ivanov, S.V.; Sumin, A.N. Current trends in routine myocardial revascularization. Complex Issues Cardiovasc. Dis. 2021, 10, 25–35. [Google Scholar] [CrossRef]
- Raza, S.; Sabik, J.F.; Ainkaran, P.; Blackstone, E.H. Coronary artery bypass grafting in diabetics: A growing health care cost crisis. J. Thorac. Cardiovasc. Surg. 2015, 150, 304–312. [Google Scholar] [CrossRef]
- Cosentino, F.; Grant, P.J.; Aboyans, V.; Bailey, C.J.; Ceriello, A.; Delgado, V.; Federici, M.; Filippatos, G.; Grobbee, D.E.; Hansen, T.B.; et al. 2019 ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD. Eur. Heart J. 2020, 41, 255–323. [Google Scholar] [CrossRef] [PubMed]
- Sousa-Uva, M.; Head, S.J.; Milojevic, M.; Collet, J.P.; Landoni, G.; Castella, M.; Dunning, J.; Gudbjartsson, T.; Linker, N.J.; Sandoval, E.; et al. 2017 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur. J. Cardiothorac. Surg. 2018, 53, 5–33. [Google Scholar] [CrossRef]
- Li, X.; Zhou, X.; Wei, J.; Mo, H.; Lou, H.; Gong, N.; Zhang, M. Effects of Glucose Variability on Short-Term Outcomes in Non-Diabetic Patients After Coronary Artery Bypass Grafting: A Retrospective Observational Study. Heart Lung Circ. 2019, 28, 1580–1586. [Google Scholar] [CrossRef]
- Chen, Y.; Zhang, H.; Hou, X.; Li, X.; Qian, X.; Feng, X.; Liu, S.; Shi, N.; Zhao, W.; Hu, S.; et al. Glycemic control and risk factors for in-hospital mortality and vascular complications after coronary artery bypass grafting in patients with and without preexisting diabetes. J. Diabetes 2021, 13, 232–242. [Google Scholar] [CrossRef]
- Li, X.; Hou, X.; Zhang, H.; Qian, X.; Feng, X.; Shi, N.; Guo, R.; Sun, H.; Feng, W.; Zhao, W.; et al. Association between stress hyperglycaemia and in-hospital cardiac events after coronary artery bypass grafting in patients without diabetes: A retrospective observational study of 5450 patients. Diabetes Obes. Metab. 2023, 25 (Suppl. S1), 34–42. [Google Scholar] [CrossRef] [PubMed]
- Siddiqui, K.M.; Asghar, M.A.; Khan, M.F.; Khan, F.H. Perioperative glycemic control and its outcome in patients following open heart surgery. Ann. Card. Anaesth. 2019, 22, 260–264. [Google Scholar] [CrossRef]
- American Diabetes Association Professional Practice Committee. 16. Diabetes Care in the Hospital: Standards of Care in Diabetes—2024. Diabetes Care 2024, 47 (Suppl. S1), S295–S306. [CrossRef]
- Dedov, I.; Shestakova, M.; Mayorov, A.; Mokrysheva, N.; Andreeva, E.; Bezlepkina, O.; Peterkova, V.; Artemova, E.; Bardiugov, P.; Beshlieva, D.; et al. Standards of Specialized Diabetes Care. Diabetes Mellit. 2023, 26, 1–157. [Google Scholar] [CrossRef]
- Li, X.; Hou, X.; Zhang, H.; Qian, X.; Feng, X.; Shi, N.; Sun, H.; Feng, W.; Zhao, W.; Li, G.; et al. Effect of early hypoglycaemia on hospitalization outcomes in patients undergoing coronary artery bypass grafting. Diabetes Res. Clin. Pract. 2022, 186, 109830. [Google Scholar] [CrossRef] [PubMed]
- Ogawa, S.; Okawa, Y.; Sawada, K.; Goto, Y.; Yamamoto, M.; Koyama, Y.; Baba, H.; Suzuki, T. Continuous postoperative insulin infusion reduces deep sternal wound infection in patients with diabetes undergoing coronary artery bypass grafting using bilateral internal mammary artery grafts: A propensity-matched analysis. Eur. J. Cardiothorac. Surg. 2016, 49, 420–426. [Google Scholar] [CrossRef] [PubMed]
- Golukhova, E.Z.; Lifanova, L.S.; Pugovkina, Y.V.; Grigoryan, M.V.; Bulaeva, N.I. Should We Monitor Glucose and Biomarkers in Diabetics over Heart Surgery? J. Clin. Med. 2021, 10, 3399. [Google Scholar] [CrossRef]
- You, H.; Hou, X.; Zhang, H.; Li, X.; Feng, X.; Qian, X.; Shi, N.; Guo, R.; Wang, X.; Sun, H.; et al. Effect of glycemic control and glucose fluctuation on in-hospital adverse outcomes after on-pump coronary artery bypass grafting in patients with diabetes: A retrospective study. Diabetol. Metab. Syndr. 2023, 15, 20. [Google Scholar] [CrossRef]
- Wang, F.; Mei, X. Association of blood glucose change with postoperative delirium after coronary artery bypass grafting in patients with diabetes mellitus: A study of the MIMIC-IV database. Front. Endocrinol. 2024, 15, 1400207. [Google Scholar] [CrossRef] [PubMed]
- Dedov, I.I.; Shestakova, M.V.; Galstyan, G.R.; Grigoryan, O.R.; Esayan, R.M.; Kalashnikov, V.Y.; Kuraeva, T.L.; Lipatov, D.V.; Mayorov, A.Y.; Peterkova, V.A.; et al. Standards of specialized diabetes care. Diabetes Mellit. 2015, 18, 1–112. [Google Scholar] [CrossRef]
- Zhang, Y.; Dai, J.; Han, X.; Zhao, Y.; Zhang, H.; Liu, X.; Li, W.; Ling, H.; Zhou, X.; Ying, C. Glycemic variability indices determined by self-monitoring of blood glucose are associated with β-cell function in Chinese patients with type 2 diabetes. Diabetes Res. Clin. Pract. 2020, 164, 108152. [Google Scholar] [CrossRef]
- Hweidi, I.M.; Zytoon, A.M.; Hayajneh, A.A.; Al Obeisat, S.M.; Hweidi, A.I. The effect of intraoperative glycemic control on surgical site infections among diabetic patients undergoing coronary artery bypass graft (CABG) surgery. Heliyon 2021, 7, e08529. [Google Scholar] [CrossRef]
- Hulst, A.H.; Visscher, M.J.; Godfried, M.B.; Thiel, B.; Gerritse, B.M.; Scohy, T.V.; Bouwman, R.A.; Willemsen, M.G.A.; Hollmann, M.W.; Preckel, B.; et al. Liraglutide for perioperative management of hyperglycaemia in cardiac surgery patients: A multicentre randomized superiority trial. Diabetes Obes. Metab. 2020, 22, 557–565. [Google Scholar] [CrossRef]
- Sindhvananda, W.; Poopuangpairoj, W.; Jaiprasat, T.; Ongcharit, P. Comparison of glucose control by added liraglutide to only insulin infusion in diabetic patient undergoing cardiac surgery: A preliminary randomized-controlled trial. Ann. Card. Anaesth. 2023, 26, 63–71. [Google Scholar] [CrossRef] [PubMed]
- Shi, F.H.; Shen, L.; Yue, J.; Ma, J.; Gu, Z.C.; Li, H.; Lin, H.W. Intervention by clinical pharmacists can improve blood glucose fluctuation in patients with diabetes and acute myocardial infarction: A propensity score-matched analysis. Pharmacol. Res. Perspect. 2021, 9, e00725. [Google Scholar] [CrossRef] [PubMed]
- Shi, F.H.; Yu, B.B.; Shen, L.; Xu, L.; Jiang, Y.H.; Gu, Z.C.; Lin, H.W.; Li, H. The Importance of Clinical Pharmacists in Improving Blood Glucose and Lipid Levels in Patients with Diabetes and Myocardial Infarction. Diabetes Metab. Syndr. Obes. 2023, 16, 2733–2744. [Google Scholar] [CrossRef] [PubMed]
- Chazal, E.; Morin, L.; Chocron, S.; Lassalle, P.; Pili-Floury, S.; Salomon du Mont, L.; Ferreira, D.; Samain, E.; Perrotti, A.; Besch, G. Impact of early postoperative blood glucose variability on serum endocan level in cardiac surgery patients: A sub study of the ENDOLUNG observational study. Cardiovasc. Diabetol. 2023, 22, 221. [Google Scholar] [CrossRef]
Indicator | Group 1 (Continuous Intravenous Insulin Infusion) n = 28 | Group 2 (Insulin Boluses) n = 186 | p |
---|---|---|---|
Male, n (%) | 16 (57.1) | 114 (61.3) | 0.448 |
Female, n (%) | 12 (42.9) | 73 (38.7) | 0.448 |
Age, years, Me [LQ; UQ] | 64.8 [60.3; 67.0] | 64.2 [59.9; 69.0] | 0.941 |
Body mass index, Me [LQ; UQ] | 27.8 [24.7; 31.1] | 28.7 [25.9; 31.7] | 0.577 |
Newly diagnosed type 2 diabetes, n (%) | 5 (17.8) | 54 (29.0) | 0.217 |
Unstable angina, n (%) | 0 (0) | 2 (1.1) | 0.994 |
FC 2 angina, n (%) | 18 (64.2) | 91 (48.9) | 0.345 |
FC 3 angina, n (%) | 6 (21.4) | 36 (19.4) | 0.786 |
Chronic heart failure FC 3 NYHA, n (%) | 2 (7.1) | 15 (8.2) | 0.313 |
Chronic heart failure FC 2 NYHA, n (%) | 26 (92.9) | 166 (89.2) | 0.359 |
History of stroke, n (%) | 2 (7.14) | 10 (5.1) | 0.653 |
History of PCI, n (%) | 3 (10.7) | 19 (10.2) | 0.922 |
History of CABG, n (%) | 0 (0) | 1 (0.5) | 0.690 |
Smoking status, n (%) | |||
| 0 (0) | 6 (3.2) | 0.717 |
| 22 (84.2) | 148 (79.5) | 0.454 |
| 5 (21.4) | 32 (17.2) | 0.610 |
Three-vessel disease by coronary angiography, n (%) | 16 (57.1) | 94 (50.5) | 0.514 |
Left main coronary artery disease, n (%) | 4 (14.3) | 25 (13.4) | 0.861 |
Stenosis of the brachiocephalic arteries, n (%) | 7 (25.0) | 46 (25.3) | 0.838 |
Left ventricular ejection fraction, Me [LQ; UQ] | 64.0 [50.0; 67.0] | 62.0 [52.0; 66.0] | 0.304 |
CKD-EPI glomerular filtration rate, Me [LQ; UQ] | 75.8 [71.6; 92.5] | 91.9 [76.7; 99.0] | 0.087 |
HbA1c before CABG, Me [LQ; UQ] | 7.4 [6.2; 8.8] | 6.9 [6.0; 7.7] | 0.224 |
Fasting blood glucose before CABG, Me [LQ; UQ] | 6.7 [5.3; 7.3] | 7.3 [6.1; 8.7] | 0.331 |
EuroSCORE 2 (%), Me [LQ; UQ] | 1.86 [1.04; 2.43] | 1.69 [1.07; 2.17] | 0.561 |
Cardiopulmonary bypass, n (%) | 27 (96.4) | 173 (93.0) | 0.689 |
Off-pump CABG, n (%) | 1 (3.6) | 13 (6.9) | 0.263 |
Isolated CABG, n (%) | 18 (64.3) | 134 (72.0) | 0.263 |
Combined surgeries, n (%) | 10 (35.7) | 52 (27.9) | 0.383 |
Aortic occlusion time, Me [LQ; UQ] | 58.0 [42.0; 78.0] | 55.0 [44.0; 70.0] | 0.847 |
Total surgery duration, hours, Me [LQ; UQ] | 3.5 [3.2; 4.5] | 3.4 [3.2; 4.2] | 0.250 |
CPB duration, minutes, Me [LQ; UQ] | 80.0 [68.0; 117.0] | 87.5 [70.5; 107.0] | 0.618 |
Mechanical ventilation duration, hours, Me [LQ; UQ] | 7.0 [5.0; 9.0] | 6.9 [5.0; 10.0] | 0.932 |
ICU duration, hours, Me [LQ; UQ] | 22.0 [21.0; 43.0] | 21.6 [19.6; 33.0] | 0.121 |
ICU duration, days, Me [LQ; UQ] | 0.90 [0.87;1.80] | 0.90 [0.76; 1.70] | 0.190 |
Renin–angiotensin system blockers | 28 (100) | 185 (99.5) | 0.938 |
β-blockers | 25 (89.3) | 168 (90.3) | 0.765 |
Calcium channel blockers | 19 (67.8) | 124 (66.7) | 0.806 |
Statins | 25 (89.3) | 167 (89.8) | 0.801 |
Mineralocorticoid receptor antagonists, n (%) | 15 (53.6) | 102 (54.8) | 0.435 |
Oral medications for the treatment of, n (%) | 22 (78.6) | 133 (71.5) | 0.296 |
Metformin, n (%) | 14 (50.0) | 92 (49.5) | 0.765 |
Sulfonylurea drugs | 13 (46.4) | 84 (45.1) | 0.533 |
DPP-4 inhibitors | 2 (7.1) | 13 (7.0) | 0.939 |
SGLT-2 inhibitors | 1 (3.6) | 4 (2.7) | 0.836 |
GLP-1 agonists | 1 (3.6) | 3 (1.6) | 0.972 |
Prehospital insulin | 4 (14.2) | 26 (14.5) | 0.804 |
Hospital insulin | 14 (50.0) | 91 (48.9) | 0.704 |
Total insulin dose on day 1, U, Me [LQ; UQ] | 38 [26; 61] | 12.2 [0; 28] | <0.001 |
Significant complications | ||||||||
95% C.I.for EXP(B) | ||||||||
B | S.E. | Wald | df | Sig. | Exp(B) | Lower | Upper | |
Average glycemia | 0.185 | 0.064 | 8.430 | 1 | 0.004 | 1.204 | 1.062 | 1.364 |
Constant | −2.778 | 0.811 | 11.718 | 1 | 0.001 | 0.062 | ||
Serious complications | ||||||||
95% C.I.for EXP(B) | ||||||||
B | S.E. | Wald | df | Sig. | Exp(B) | Lower | Upper | |
Average glycemia | 0.144 | 0.062 | 5.471 | 1 | 0.019 | 1.155 | 1.024 | 1.304 |
Constant | −2.285 | 0.785 | 8.477 | 1 | 0.004 | 0.102 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Sumin, A.N.; Bezdenezhnykh, N.A.; Shukevich, D.L.; Bezdenezhnykh, A.V.; Barbarash, O.L. Continuous Intravenous Insulin Infusion in Patients with Diabetes Mellitus After Coronary Artery Bypass Grafting: Impact on Glycemic Control Parameters and Postoperative Complications. J. Clin. Med. 2025, 14, 3230. https://doi.org/10.3390/jcm14093230
Sumin AN, Bezdenezhnykh NA, Shukevich DL, Bezdenezhnykh AV, Barbarash OL. Continuous Intravenous Insulin Infusion in Patients with Diabetes Mellitus After Coronary Artery Bypass Grafting: Impact on Glycemic Control Parameters and Postoperative Complications. Journal of Clinical Medicine. 2025; 14(9):3230. https://doi.org/10.3390/jcm14093230
Chicago/Turabian StyleSumin, Alexey N., Natalia A. Bezdenezhnykh, Dmitry L. Shukevich, Andrey V. Bezdenezhnykh, and Olga L. Barbarash. 2025. "Continuous Intravenous Insulin Infusion in Patients with Diabetes Mellitus After Coronary Artery Bypass Grafting: Impact on Glycemic Control Parameters and Postoperative Complications" Journal of Clinical Medicine 14, no. 9: 3230. https://doi.org/10.3390/jcm14093230
APA StyleSumin, A. N., Bezdenezhnykh, N. A., Shukevich, D. L., Bezdenezhnykh, A. V., & Barbarash, O. L. (2025). Continuous Intravenous Insulin Infusion in Patients with Diabetes Mellitus After Coronary Artery Bypass Grafting: Impact on Glycemic Control Parameters and Postoperative Complications. Journal of Clinical Medicine, 14(9), 3230. https://doi.org/10.3390/jcm14093230