Diabetes- a significant contributor to complications in cardiac surgery: How and when to optimise glycaemic control

Objective: The aim is to present the literature on the association between pre--operative hyperglycaemia and post--operative complications and to review the current interventions (pre surgery, peri /intra-- and post--operatively) in those with diabetes undergoing cardiac surgery. Design: A literature review was undertaken to examine complications and interventions in those with diabetes undergoing cardiac surgery. Setting: Acute care. Subjects: Those with diabetes undergoing cardiac surgery. Main outcome measures: Mortality and morbidity and improved glycaemic control. Results: Pre-operative hyperglycaemia is associated with wound infections and prolonged length of hospital stay. Studies on intra- and post-operative medical interventions to control glycaemia in cardiac surgical patients demonstrate improved short-term medical outcomes, including decreased mortality and improved glycaemic control, reduction in infection rates and reduced length of stay. Some studies examined the roles of pre-operative glucose management (using glycosylated haemoglobin, HbA1c) prior to surgery and demonstrated that HbA1c can be decreased in short term post-educational interventions. Improvements in physical functioning and quality of life post-educational interventions have been reported. Although the primary outcome is often HbA1c, patient focused outcomes (such as empowerment and education) are equally as important in this chronic condition. Conclusion: Diabetes is a chronic condition and patients need to be educated about the association between coronary artery disease and diabetes and the importance of glycaemic control. Interventions can improve glycaemic control in the short-term as well increasing patients' empowerment and self-mastery. There is evidence supporting the benefits of educational interventions in those with diabetes undergoing cardiac surgery.