Coronary artery bypass graft surgery in patients with diabetes

Diabetes is a potent risk factor for cardiovascular disease. Whatever the treatment, the prognosis of coronary artery disease is poorer inpatients with diabetes than in non diabetic patients. Strict equilibration of perioperative glycemia reduces morbidity and mortality associated with coronary artery bypass graft surgery (CABG). Patients and methods: In two hundred consecutive diabetic patients who underwent CABG, perioperative glycemia was equilibrated by using a new aggressive protocol (Group A), In-hospital morbidity and mortality observed in these patients was compared to that observed in 200 diabetic patients who underwent CABG before the protocol was implemented (group B). Results: Preoperative data were similar in the two groups. The mean number of grafts was 2.6 per patient, and the left internal thoracic artery was used in 98 % of cases. Use of the two internal mammary arteries increased from 16 % in group B to 38 % in group A (p < 0.05). However the rates of wound infection and mediastinitis were similar in the two, groups (4 %), as was the rate of other complications. In contrast, in-hospital mortality was twice as lower in group A (1.5 %) than in group B (3.5 %). One-quarter of the patients used insulin, and the rate of infectious complications was higher in this subgroup; however, in-hospital mortality was similar to that among diabetic patients not requiring insulin (2 %). Use of the protocol did not affect the outcome of patients requiring insulin. Conclusion : Better medical and surgical management of diabetic patients is improving the outcome of CABG surgery, with results now similar to those obtained in non diabetic patients. The use of mammary arteries improves long-term survival. Surgical revascularization remains the most effective treatment for diabetic patients whose coronary artery lesions do not qualify for endovascular revascularization.