Glucosa-Insulin-Potassium (GIK) Solution Used with Diabetic Patients Provides Better Recovery After Coronary Bypass Operations

Abstract

I ntroduction: Tight blood glucose control has become a therapeutical goal for anesthetic management for patients scheduled for cardiac surgery, especially if they are diabetic patients. Aim: This study was created to confirm the benefits of intraoperative GIK solution usage during coronary bypass operation of diabetic patients. Methods: Patients with type 1 and 2 diabetes mellitus (DM) referred for coronary artery bypass grafting (CABG) were randomized to receive GIK solution (GIK -study group) in the first 24 hours intraoperatively or to receive official Clinical protocol without GIK solution (non GIK -control group). The primary clinical outcome was the cardiac index (CI) since it represents the most sensitive measure of cardiac work in the immediate postoperative period, and the secondary clinical outcomes were the glycemic control, insulin consumption, duration of mechanical ventilation (MV), potassium level and atrial fibrillation (AF) appearance. Results: One hundred diabetic patients, divided into two groups, were included in the study. The cardiac index did not show a significant difference, although the study group had CI with only minor variations than those of the controlled group, hence the reason we considered the study group as the more stable. The atrial fibrillation showed a difference between two groups, with 14 (28%) patients with postoperative AF in the control group compared with 3 (6%) patients with postoperative AF in the study group. As potassium values were stable in study group, we concluded that it can be one of the reasons for less postoperative AF in this group. The duration of MV showed a significant difference (0,003) between the two groups as well. In the study group the average MV time was 534,38 minutes, compared with the control group with 749,20 minutes. The average value of glucose was 11.1 mmol/l in the control group vs. 9.8 mmol/l in the study group. The study group had less insulin consumption in order to maintain target glycemia (p=0,001). In the non GIK group average insulin consumption was 44 IJ per patient vs. 28,5 IJ in the GIK group. Conclusion: Intraoperative GIK solution given to diabetic patients with CABG operation provides more stable CI, shorter time of MV, more stable values of potassium which provides normal rhythm and less AF onset, less insulin to maintain target glycemia. All the above mentioned provides more stable intraoperative hemodynamic and better recovery of diabetic patients with coronary artery bypass operations.

O-GlcNAcylation and cardiovascular disease

“…However, the adoption of GIK therapy in normal clinical practice remains controversial largely because of variable outcomes in clinical trials [12, 13], although there is more of a consensus of its utility in the setting of cardiac surgery [14, 15]. Another limitation is a lack of agreement as to the mechanism underlying the cardioprotective effects of GIK therapy.…”

Insulin and β Adrenergic Receptor Signaling: Crosstalk in Heart

“…In agreement, administration of glucose insulin potassium (GIK) in acute ischemia improves hemodynamic performance and reduces mortality. These effects are also associated with suppression of myocardial fatty acid oxidation, greater glucose consumption, increased SERCA2a and phospholamban mRNA expression [91, 92]. In contrary, long-term βAR stimulation inhibits insulin-induced phosphorylation of ERK1/2 and JNK [2], which are required for insulin to exert its protective effect against the hypoxia-induced activation of pro-apoptotic caspase-3 [2].…”

Glucose-Insulin-Potassium Alleviates Intestinal Mucosal Barrier Injuries Involving Decreased Expression of Uncoupling Protein 2 and NLR Family-Pyrin Domain-Containing 3 Inflammasome in Polymicrobial Sepsis

“…GIK, an effective prescription for coronary heart disease and other heart diseases clinically [9, 26, 27], has been shown to exert anti-inflammatory effects to attenuate the systemic inflammatory response in endotoxemia rats and humans by inactivating nuclear factor κ B or the phosphoinositide 3-kinase/Akt signaling pathway [28]. GIK is a “cocktail” recipe that consists of dextrose, insulin, and potassium: insulin has a bioactive role in the anti-inflammatory, antioxidation, and antiapoptotic effects in various conditions; dextrose resists hypoglycemia; insulin and dextrose together assist the transfer of potassium from extracellular to intracellular fluids; and all three components work together to exert bioactive effects without the side effects of hypoglycemia and hypokalemia [29].…”

“…Glucose-insulin-potassium (GIK) therapy has been reported to decrease mortality among critically ill patients due to its suppression of inflammatory and apoptotic effects and has been used clinically for decades [9]. Insulin, which has now been confirmed to be the major bioactive component of GIK, can decrease pyruvate production and glycolysis and increase glycogen synthesis, which may result in reduced production of lactate during sepsis [10].…”