Abstract
BACKGROUND: Hyperglycemia is common after coronary artery bypass grafting (CABG) among patients with diabetes and has been associated with increased morbidity rates. The conventional strategies involving sliding-scale insulin therapy alone or continuous IV infusion alone are frequently ineffective due to the lack of basal insulin support. OBJECTIVES: To evaluate whether adding subcutaneous glargine to continuous intravenous regular insulin enhances glycaemic control and postoperative outcomes among diabetic patients who undergo CABG. METHODS: This is a prospective observational study carried out among 260 diabetic patients scheduled to undergo elective CABG at the National Institute of Cardiovascular Diseases, Dhaka. The patients were randomly divided into two groups: Group A received continuous IV regular insulin alone, and Group B received continuous IV regular insulin and once-daily subcutaneous glargine. Blood glucose levels were recorded until the second day after the operation. The postoperative complications and outcomes were recorded. RESULTS: The mean postoperative blood glucose levels were significantly lower in Group B compared to Group A (mean 9.25 ± 0.84 vs. 12.14 ± 0.77 mmol/L; p <0.001). Group B also had a significantly lower incidence of acute kidney injury (2.3% vs. 23.1%, p <0.001) and sternal wound infection (0.8% vs. 13.1%, p <0.001). The duration of postoperative hospitalisation was less for Group B (9.5 ± 1.3 vs 10.5 ± 1.7 days, p <0.001). Mortality rates were equally matched by the two groups. CONCLUSION: The study concludes that combining subcutaneous glargine with continuous intravenous infusion of insulin achieves optimal glycaemic control following surgery and reduces morbidity amongst diabetic CABG patients when compared with intravenous insulin alone.