Four articles recently published in The Journal of Thoracic and Cardiovascular Surgery offer new concerning data on one serious health problem worldwide: diabetes accompanied by coronary artery disease.
Diabetes is a condition where the lack of insulin leads to insulin resistance and eventually to higher blood sugar levels. Insulin is a hormone essential to control blood sugar levels and convert sugar, starches and other foods into energy.
A study developed by researchers at the Cleveland Clinic entitled “Coronary artery bypass grafting in diabetics: A growing health care cost crisis,” reveals that there is an increasing number of patients with diabetes and coronary artery disease who require surgical revascularization.
In the study, researchers analyzed the prevalence trends of diabetes and cardiovascular risk factors in the last four decades (1972 to 2011) among patients submitted to coronary artery bypass grafting (CABG), and compared the clinical outcomes and long-term survival rates after CABG in patients with diabetes (10,362 patients) and without (45,139).
The team found that the rate of diabetic patients undergoing CABG increased from 7% to 37% in four decades. Furthermore, the clinical outcomes in diabetic patients became worse in comparison to nondiabetic, represented by a higher number of in-hospital deaths, renal failure, strokes, wound infections and prolonged postoperative hospital stay. The survival rate after CABG was also found to have worsened in time among diabetic patients in comparison to nondiabetic, with the 10 and 20 year survival being 56 and 20% for diabetics, and 66 and 32% for nondiabetics, respectively. In terms of healthcare costs, these were 9% higher among diabetic patients who underwent CABG.
The findings led the authors to conclude that “Diabetes is both a marker for high-risk, resource-intensive, and expensive care after CABG, and an independent risk factor for reduced long-term survival,” said the study’s lead author Dr. Joseph F. Sabik III in a news release. “Clearly, policies and programs focused on controlling the factors that promote diabetes are critical to improving global public health and reining in the rising cost of healthcare.”
Editorial comments to this study emphasized the diabetes burden for the society. “The Cleveland Clinic Study provides many important historical, clinical, and social insights. Their careful data analysis seems to have teased out the associated comorbidities from the mere fact of diabetes itself, to suggest that the incremental impact of diabetes, independent of associated risk factors, is not discernible in the early postoperative period, but rather takes an increasing toll on late mortality,” said Dr. Paul Kurlansky from Columbia University Medical Center, who was involved in one of the editorial comments.
“The weight may be increasingly on our patients, but the real weight is on us as surgeons to help improve their early- and long-term survival,” concluded Drs. Mani Arsalan and Michael Mack from Baylor Research Institute on another editorial comment.