Prevalence and risks of undiagnosed diabetes mellitus in patients undergoing coronary artery bypass grafting

Lauruschkat AH, Arnrich B, Albert AA, et al. Prevalence and risks of undiagnosed diabetes mellitus in patients undergoing coronary artery bypass grafting. Circulation. 2005;112(16):2397-2402.Background— Numerous studies have shown that diabetes mellitus (DM) is not identified and, consequently, inadequately treated in a substantial proportion of the patients in the general population. We know very little about the extent and the consequences of undiagnosed diabetes in the risk group of patients with coronary heart diseases. The objective of this study was therefore to determine the prevalence and the risks of undiagnosed DM among patients with coronary artery bypass. Methods and Results— The data of 7310 patients who have undergone coronary bypass operations between 1996 and 2003 were analyzed. Depending on their diagnosis on admission and their fasting plasma glucose (FPG) level, these patients were classified as known diabetics, undiagnosed diabetics (FPG ≥126 mg/dL), or as nondiabetics (FPG 1 day (5.6% versus 10.5% versus 7.4%; P<0.01). Perioperative mortality rate was highest in this group (0.9% versus 2.4% versus 1.4%; P<0.01). Conclusions— This study is the first to publish the prevalence of undiagnosed diabetes mellitus in cardiac surgery. During the perioperative and postoperative courses, these patients displayed a substantially higher morbidity and mortality rate

Erfahrungen mit Diabetikern in der Koronarchirurgie - Patienten mit einem besonderen Risikoprofil

Lauruschkat AH, Albert AA, Arnrich B, et al. Erfahrungen mit Diabetikern in der Koronarchirurgie - Patienten mit einem besonderen Risikoprofil. Clinical Research in Cardiology. 2006;95(1 Supplement):7-13.Background The objective of this paper was to analyze demographic and clinical characteristics of diabetic patients undergoing coronary artery bypass grafting on the basis of a significant number of cases. Methods The data of 8,195 patients who have undergone coronary bypass operations between 1996 and 2003 were analyzed. Non-diabetic patients (no DM), oral treated diabetics (DM oral) and insulin-treated diabetics (DM insulin) were compared in terms of their pre-operative, intra-operative and post-operative characteristics. The statistical analyses were performed with the support of SPSS 11.5 under application of chi-square and student-t tests. Results In cardiosurgery, diabetics differ in various ways from non-diabetic patients. They show a significantly higher prevalence of the known cardiovascular risk factors such as raised body mass index, age and hypertension. Furthermore they present a higher prevalence of vascular comorbidity such as peripheral vascular disease and carotid disease. At the postoperative stage, cerebral dysfunction occurred more often among the diabetic patients (no DM 5.2% vs. DM oral 7.3% vs. DM insulin 10.5%; p<0.05), they suffered from apoplexies more frequently (no DM 1.9% vs. DM oral 2.1% vs. DM insulin 3.2%; p<0.05), and they required re-intubation more frequently (no DM 2.6% vs. DM oral 3.1% vs. DM insulin 5.6%; p<0.05). Peri-operative mortality was highest in the group of insulin-treated diabetics (no DM 1.1% vs. DM oral 1.6% vs. DM insulin 1.8%; p<0.05). Conclusion In coronary surgery, diabetic patients represent an especially challenging patient group with an independent risk profile, who require specific consideration as far as the selection of the operative approach, on, one hand, and the post-operative follow-up, on the other hand, are concerned.Einleitung Anhand eines aussagekräftigen Patientenkollektivs sollten die demographischen, klinischen, operativen und postoperativen Daten diabetischer Koronarpatienten mit nichtdiabetischen Patienten verglichen werden. Methoden und Ergebnisse Es wurden die Daten von 8 195 Patienten untersucht, die sich im Zeitraumvon 1996 bis 2002 koronaren Bypassoperationen unterzogen. Nichtdiabetische Patienten (kein DM), mit oralen Antidiabetika therapierte Diabetiker (DM oral) und mit Insulin therapierte Diabetiker (DM Insulin) wurden hinsichtlich ihrer präoperativen Charakteristika und Risikofaktoren und hinsichtlich der Ergebnisse des postoperativen Verlaufs miteinander verglichen. Es zeigte sich, dass diabetische Koronarpatienten signifikant häufiger zahlreiche kardiovaskuläre Risikofaktoren und eine höhere vaskuläre Komorbidität aufwiesen als nichtdiabetische Patienten. Postoperativ litten Diabetiker häufiger unter Verwirrtheitszuständen (kein DM 5,2% vs. DM oral 7,3% vs. DM Insulin 10,5%; p<0,05), erlitten häufiger Schlaganfälle (kein DM 1,9% vs. DM oral 2,1% vs. DM Insulin 3,2%; p<0,05) und mussten häufiger reintubiert werden (kein DM 2,6% vs. DM oral 3,1% vs. DM Insulin 5,6%; p<0,05). Die 30-Tage-Mortalität war unter den Diabetikern signifikant erhöht (kein DM 1,1% vs. DM oral 1,6% vs. DM Insulin 1,8%; p<0,05). Schlussfolgerung Die Ergebnisse der vorliegenden Studie zeigen, dass diabetische Koronarpatienten in der Herzchirurgie ein eigenständiges Risikoprofil aufweisen, das in der Wahl der operativen Strategien und im postoperativen Verlauf eine besondere Herausforderung darstellt

Diabetes mellitus as a risk factor for pulmonary complications after coronary bypass surgery

Lauruschkat AH, Arnrich B, Albert AA, et al. Diabetes mellitus as a risk factor for pulmonary complications after coronary bypass surgery. JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY. 2008;135(5):1047-1053