Metformin as an adjunct to insulin for glycemic control in patients with type 2
diabetes after CABG surgery: a randomized double blind clinical trial.
Author(s): Baradari AG, Zeydi AE, Aarabi M, Ghafari R.
Affiliation(s): Department of Critical Care Medicine, Faculty of Medicine, Mazandaran University
of Medical Sciences, Sari, Iran.
Publication date & source: 2011, Pak J Biol Sci. , 14(23):1047-54
Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing
Coronary Artery Bypass Graft (CABG) surgery and there is a direct relation
between postoperative hyperglycemia and mortality rate in these patients. The aim
of the present study is to determine the efficacy of metformin on glycemic
control in diabetic patients after CABG surgery. In a randomized double blind
clinical trial, 100 patients with type 2 diabetes admitted in open heart ICU
after CABG surgery in Mazandaran Heart Center were enrolled. They were randomly
assigned to two intervention and control groups. Three hours after extubation,
therapeutic antiglycemic regimens were applied in these two groups and continued
for three days. Intervention group received regular insulin infusion along with
two metformin 500 mg tablets per twelve hours while control group received
regular insulin infusion with two placebo tablets per twelve hours. Blood glucose
level and other parameters were measured and recorded in determined intervals. To
analyze the data, independent T-test, paired T-test, Mann-Whitney and repeated
measure ANOVA tests were employed. Mean blood glucose level was not significantly
different in the two groups at the beginning of the ICU admission; however, mean
glucose level in insulin-metformin group, twelve hours after the initiation of
the study, was significantly lower than insulin group (p < 0.05). In addition,
mean doses of potassium and insulin demand as well as mean number of episodes of
hyperglycemia, hypoglycemia and glucose levels out of the accepted range were
significantly lower in insulin-metformin group (p < 0.05). Alterations in mean
levels of lactate, BE, pH and creatinine were not statistically significant in
these two groups. It seems that adding metformin to insulin leads to a better
glycemic control in type two diabetic patients undergoing CABG surgery without
causing metabolic acidosis. Therefore, it might be a potential option in blood
glucose control protocol in this group of patients.
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