Uncontrolled diabetes mellitus; results of cytokines and endothelial function during coronary artery bypass surgery

Objective: Unregulated type 2 diabetes mellitus is a major risk factor for coronary artery bypass surgery [CABG]. Perioperative values of cytokines and the endothelial function of diabetic patients who have controlled and uncontrolled glucose were compared according to HbA1c levels. The parameters were analyzed and compared following the hospital admission and started to the appropriate treatment. Methods: Forty patients undergoing CABG were included the study. Patients were divided into 3 groups according to preoperative HbA1c levels; the patients who had HbA1c level below 7 [group 2], HbA1c values in between 7-10 [group 3], above 10 [group 4] were marked as groups 1-3 and additional 10 non diabetic patients were included as the control group [group 1]. Results: The demographic data of the patients were not significantly changed among the groups except female gender. Postoperative inotropic support necessity was high especially in group 4. Preoperative endothelial dysfunction was also severely impaired in the high HbA1c groups but this difference was returned to nonsignificant level following treatment. Noninvasive endothelial function was calculated as 2.0 in control group but 0.69±0.32, 1.36±0.69, 0.99±0.15 in groups 2-4. Apelin, soluble intercellular adhesion molecule and Platelet Activating Factor levels were changed significantly among the groups [p<0.002]. Conclusion: We indicate that HbA1c level is an important predictor of morbidity during the CABG surgery. In our study there is a significant difference between diabetic and non-diabetic patients in terms of both endothelial function and some of the inflammatory cytokines. These parameters improved by the time and following the appropriate treatment of diabetes mellitus but effect the CABG surgery.