Glucose-insulin-potassium solutions improve outcomes in diabetics who have coronary artery operations

Background. This study was undertaken to determine whether glucose-insulin-potassium (GIK) would improve myocardial performance and limit morbidity after coronary artery bypass grafting in diabetic patients. Methods. Forty consecutive coronary artery bypass grafting patients with medically treated diabetes mellitus were prospectively randomly assigned to either a GIK group (n = 20; 500 mL D 5W + 80 U regular insulin + 40 mEq KCl 30 mL/hour) or a no-GIK group (n = 20; D 5W at 30 mL/hour). The GIK was begun at anesthetic induction and continued for 12 hours postoperatively. Results. Patients treated with GIK had higher postoperative cardiac indices (2.88 ± 0.50 versus 2.20 ± 0.39 L/minute per square meter; p < 0.0001), lower inotrope scores (0.40 ± 0.68 versus 1.25 ± 1.44; p = 0.05), less weight gain (5.80 ± 3.76 versus 13.85 ± 6.52 pounds; p < 0.0001), and had shorter times of ventilator support (8.35 ± 2.60 versus 13.45 ± 7.33 hours; p = 0.0128). They had a significantly lower prevalence of atrial fibrillation (15% versus 60%; p = 0.003), and shorter hospital stays (6.70 ± 1.52 versus 10.15 ± 6.62 days; p = 0.02). Conclusions. Substrate enhancement with GIK in diabetic patients improved myocardial performance and resulted in faster recovery after coronary artery bypass grafting.