PMID- 26962814
OWN - NLM
STAT- MEDLINE
DCOM- 20160726
LR  - 20220310
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Print)
IS  - 0025-7974 (Linking)
VI  - 95
IP  - 10
DP  - 2016 Mar
TI  - Comparing the Clinical Outcomes Between Insulin-treated and Non-insulin-treated 
      Patients With Type 2 Diabetes Mellitus After Coronary Artery Bypass Surgery: A 
      Systematic Review and Meta-analysis.
PG  - e3006
LID - 10.1097/MD.0000000000003006 [doi]
LID - e3006
AB  - Several studies have shown coronary artery bypass surgery (CABG) to be beneficial 
      in patients with type 2 diabetes mellitus (T2DM) and multivessel coronary artery 
      diseases. Patients with insulin-treated T2DM (ITDM) are usually patients with 
      poor glycemic control and are expected to suffer more complications compared with 
      patients with non-insulin-treated T2DM (NITDM). However, the adverse clinical 
      outcomes in patients with ITDM and NITDM after CABG are still not very clear. 
      Hence, to solve this issue, we aim to compare the short-and long-term adverse 
      clinical outcomes in a larger number of patients with ITDM and NITDM after CABG, 
      respectively.Randomized controlled trials and observational studies comparing the 
      adverse clinical outcomes such as mortality, major adverse events (MAEs), stroke, 
      myocardial infarction, and repeated revascularization in patients with ITDM and 
      NITDM after CABG have been searched from Medline, EMBASE, Cochrane, and PubMed 
      databases. A short-term follow-up (</=30 days) and a long-term follow-up (>/=1 year) 
      were considered. Odds ratio (OR) with 95% confidence interval (CI) was used to 
      express the pooled effect on discontinuous variables and the pooled analyses were 
      performed with RevMan 5.3.Eleven studies involving a total of 64,152 patients 
      with T2DM (23,781 patients with ITDM and 40,371 patients with NITDM) have been 
      included in this meta-analysis. During the short-term follow-up period, patients 
      with ITDM had a significantly higher mortality (OR: 1.47; 95% CI: 1.33-1.61, 
      P < 0.00001) and MAEs (OR: 1.66; 95% CI: 1.48-1.87, P < 0.00001). During the 
      long-term follow-up period, patients with ITDM still had a significantly higher 
      rate of mortality, MAEs, and stroke (OR: 1.23, 95% CI: 1.02-1.49, P = 0.03; OR: 
      1.50, 95% CI: 1.07-2.12, P = 0.02; OR: 1.39, 95% CI: 1.22-1.59, P < 0.00001, 
      respectively) after CABG. However, our results showed similar repeated 
      revascularization rate between the ITDM and NITDM groups after CABG (OR: 1.31, 
      95% CI: 0.81-2.12, P = 0.27).According to this study, patients with ITDM had a 
      significantly higher rate of mortality and MAEs compared with patients with NITDM 
      after CABG. Stroke was also significantly higher in patients with ITDM during a 
      long-term follow-up period. However, since the result for the long-term mortality 
      had a higher heterogeneity as compared with the other subgroups, and because a 
      similar revascularization rate was observed between the ITDM and NITDM groups 
      after CABG maybe because of a limited number of patients analyzed, further 
      studies still need to be conducted to completely solve this issue.
FAU - Munnee, Krishna
AU  - Munnee K
AD  - From the Department of Oral and Maxillofacial Surgery, Xiangya Hospital, Central 
      South University, Changsha, Hunan (KM, HQ, ZT, ); Institute of Cardiovascular 
      Diseases, the First Affiliated Hospital of Guangxi Medical University, Nanning, 
      Guangxi, People's Republic of China (PKB).
FAU - Bundhun, Pravesh K
AU  - Bundhun PK
FAU - Quan, Hongzhi
AU  - Quan H
FAU - Tang, Zhangui
AU  - Tang Z
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
RN  - 0 (Hypoglycemic Agents)
RN  - 0 (Insulin)
SB  - IM
MH  - *Coronary Artery Bypass
MH  - *Coronary Artery Disease/complications/mortality/surgery
MH  - *Diabetes Mellitus, Type 2/complications/drug therapy/mortality
MH  - Global Health
MH  - Humans
MH  - Hypoglycemic Agents/therapeutic use
MH  - Insulin/*therapeutic use
MH  - Postoperative Period
MH  - Survival Rate/trends
PMC - PMC4998895
COIS- The authors report no conflicts of interest.
EDAT- 2016/03/11 06:00
MHDA- 2016/07/28 06:00
PMCR- 2016/03/11
CRDT- 2016/03/11 06:00
PHST- 2016/03/11 06:00 [entrez]
PHST- 2016/03/11 06:00 [pubmed]
PHST- 2016/07/28 06:00 [medline]
PHST- 2016/03/11 00:00 [pmc-release]
AID - 00005792-201603080-00051 [pii]
AID - 10.1097/MD.0000000000003006 [doi]
PST - ppublish
SO  - Medicine (Baltimore). 2016 Mar;95(10):e3006. doi: 10.1097/MD.0000000000003006.