Insulin Pump Therapy in the Coronary Artery Bypass Grafting Postoperative Period

Aim. To assess an efficacy of continuous glucose monitoring system (CGMS) combined with insulin pump therapy for perioperative glycemic control after coronary artery bypass grafting (CABG).
Design. Prospective comparative study.
Materials and methods. We used CGMS for 72 hours in 105 patients with coronary artery disease including 52 ones with diabetes mellitus type 2 (DM2). Patients with DM2 were divided into 2 subgroups: insulin pump therapy (subgroup 1) and bolus intravenous insulin according to in-hospital protocol (subgroup 2). We analyzed pro-inflammatory markers, adipokines and incidence of postoperative complications in one hour, 12 hours, 7 days and 1 year after CABG.
Results. Insulin pump therapy ensured target glycemia in most cases (62.5%) while bolus intravenous insulin injection was followed by normal glucose level in 21.4% of patients (p = 0.003). Insulin pump therapy significantly decreased highly sensitive C-reactive protein after 12 hours (p = 0.0001), RANTES after 7 days (p = 0.035). In patients on insulin pump therapy the leptin level after 7 days was significantly lower than in the subgroup 2 (p = 0.039). There was a negative relationship between the leptin level after 7 days and the use of CGMS combined with insulin pump therapy (r = –0.73; p = 0.025). In patients on insulin pump therapy the adiponectin level after 1 year was significantly higher than in the subgroup 2 (p = 0.028). Insulin pump therapy decreased the incidence of postpericardiotomy syndrome (p = 0.03) and the period of hospitalization (p = 0.007), but there was no significant difference in the rate of complications in the long-term period.
Conclusion. CGMS combined with insulin pump therapy is safe and effective for perioperative glycemic control, as well as decrease of the incidence of postpericardiotomy syndrome.

1. Monlun M., Rigalleau V., Blanco L., Momammedi K. et al. Chronic low grade inflammation in type 2 diabetes — activation of the inflammasomes by circulating metabolites. Diabetes. 2018;67(suppl.1):1726-P. DOI: 10.2337/db18-1726-P

2. Gramlich Y., Daiber A., Buschmann K., Oelze M. et al. Oxidative stress in cardiac tissue of patients undergoing coronary artery bypass graft surgery: the effects of overweight and obesity. Oxid. Med. Cell Longev. 2018: 2018:6598326. DOI: 10.1155/2018/6598326

3. Galindo R.J., Fayfman M., Umpierrez G.E. Perioperative management of hyperglycemia and diabetes in cardiac surgery patients. Endocrinol. Metab. Clin. North Am. 2018;47(1):203–22. DOI: 10.1016/j.ecl.2017.10.005

4. Olczuk D., Priefer R. A history of continuous glucose monitors (CGMs) in self-monitoring of diabetes mellitus. Diabetes Metab. Syndr. 2018;12(2):181–7. DOI: 10.1016/j.dsx.2017.09.005

5. Umpierrez G.E., Klonoff D.C. Diabetes technology update: use of insulin pumps and continuous glucose monitoring in the hospital. Diabetes Care. 2019;42(4):e66–7. DOI: 10.2337/dci18-0066

6. Golukhova E.Z., Magomedova N.M., Chebotareva G.E. Comparative analisis of the dynamics of glycemia using continuous glucose monitoring during on-pump or off-pump coronary artery bypass grafting. Diabetes Mellitus. 2016;19(1):44–52. (in Russian). DOI: 10.14341/DM7710

7. Mou Y., Ma D., Zhang J., Tao J. et al. Continuous subcutaneous insulin infusion reduces the risk of postoperative infection. J. Diabetes. 2020;12(5):396–405. DOI: 10.1111/1753-0407.13008

8. Wasmuth H.E., Kunz D., Graf J., Stanzel S. et al. Hyperglycemia at admission to the intensive care unit is associated with elevated serum concentrations of interleukin-6 and reduced ex vivo secretion of tumor necrosis factor-alpha. Crit. Care Med. 2004;32(5):1109–14. DOI: 10.1097/01.CCM.0000124873.05080.78

9. Dandona P., Chaudhuri A., Ghanim H., Mohanty P. Insulin as an anti-inflammatory and antiatherogenic modulator. JACC. 2009;53(5 suppl.):S14–20. DOI: 10.1016/j.jacc.2008.10.038

10. Rodriguez-Araujoa G., Nakagami H. Pathophysiology of cardiovascular disease in diabetes mellitus. Cardiovasc. Endocrinol. Metab. 2018;7(1):4–9. DOI: 10.1097/XCE.0000000000000141

11. Carey P.E., Stewart M.W., Ashworth L., Taylor R. Effect of insulin therapy on plasma leptin and body weight in patients with type 2 diabetes. Horm. Metab. Res. 2003;35(6):372–6. DOI: 10.1055/s-2003-41360