Glucose Variability IN Diabetic Patients Receiving DEXmedetomidine During Off-Pump Coronary Artery Bypass Grafting: GV-IN-DEX, A Randomised Controlled Trial.

INTRODUCTION

Diabetes mellitus (DM) is a complex carbohydrate metabolic disorder with increased levels of inflammation. Stress response to cardiac surgery manifests as a major neuroendocrine and cytokine response leading to increased levels of inflammation and subsequent hyperglycemia, contributing to significant cardiovascular morbidity and mortality. To mitigate these effects in patients undergoing off-pump coronary artery bypass grafting (OPCABG), our study focused on using dexmedetomidine infusion hypothesizing decreased stress response and thereby improved glucose variability (GV).

METHODS

Patients were randomized into two groups: group D (dexmedetomidine) was administered the drug at 0.5 µg/kg/h, and group C (control) was administered an equivalent amount of saline. Preinduction C-reactive protein (CRP) and interleukin-6 (IL-6) levels were sent, and perioperative GV and mean insulin requirement were recorded in 24 h. Postoperatively, samples were sent and recorded for IL-6 and CRP levels at 12 and 24 h. The primary objective of our study was to assess the effect of injection dexmedetomidine on blood GV with secondary objectives being the assessment of the level of IL-6 and CRP at preinduction (0 h) and at 12 and 24 h postoperatively and comparison of mean insulin requirement between the groups.

RESULTS

Eighty-nine diabetic patients were enrolled in this study, among which 21 were excluded. Sixty-eight patients, with 34 patients in each group, were selected for analysis. There was a significant difference between the two groups in terms of GV (P = 0.042) (16.44 ± 4.63 vs. 14.38 ± 3.45), mean insulin requirements (U/h) (P = 0.001) (1.38 ± 0.63 vs. 0.88 ± 0.59), CRP (mg/dL) (12 h) (P = 0.012) (2.6 ± 2.83 vs. 1.51 ± 1.13, and CRP (mg/dL) (24 h) (P = <0.001) (16.71 ± 6.45 vs. 10.19 ± 4.56). IL-6 was comparable in both groups at all points.

CONCLUSION

Patients receiving intraoperative dexmedetomidine infusion during OPCABG demonstrated improved GV leading to a reduction in insulin requirements and reduced CRP levels at 12 and 24 h postoperatively. We may incorporate dexmedetomidine in our routine clinical practice to ameliorate stress response in these patients.