Efficacy of Carbohydrate Loading in Diabetic Type 2 Patients Undergoing CABG Surgery on CPB

A randomized controlled trial comparing diabetic type 2 patients receiving carbohydrate loading with those undergoing traditional fasting protocols. Patients will be randomized to two groups; group (a) patients will have carbohydrate loading 2 hours before the surgery (400 ml of 12.5 maltodextrin and 400 ml of over-the-counter fruit-based lemonade), while group (b) patients (control group) will have standard fasting protocol 8 hours before surgery.

Aims of the study:

1. To assess the efficacy of carbohydrate loading in reducing insulin resistance in diabetic type 2 patients undergoing CABG surgeries.
2. To monitor clinical outcomes such as infection rates, ICU stay duration, and need for inotropic and vasoactive drugs.
3. To evaluate changes in inflammatory markers including CRP levels. clinical outcome

• Carbohydrate loading before surgery (Dietary supplement): Carbohydrate loading 2 hours before the surgery (400 ml of 12.5 maltodextrin and 400 ml of over-the-counter fruit-based lemonade)

Primary outcomes

• Short Insulin Tolerance Test (KITT) [Preoperatively and up to 72 hours postoperatively]: Short Insulin Tolerance Test (KITT) will test changes in insulin tolerance postoperatively

Secondary outcomes

• CRP levels [Preoperatively and up to 72 hours postoperatively]: C-Reactive Protein levels in the blood
• Arterial blood gases [Preoperatively and up to 72 hours postoperatively]: Changes in arterial blood gases
• Operative time [Intraoperatively, skin-to-skin]: Total operative time, skin-to-skin
• CPB duration [Intraoperatively, using extracorporeal circulation]: Total time spend using cardiopulmonary bypass perfusion
• Blood loss [Intraoperatively and up to 72 hours postoperatively]: Blood loss and blood product usage
• Number of grafts performed [Intraoperatively, skin-to-skin]: Number of grafts performed during the operation
• Use of inotrops [Intraoperatively and up to 72 hours postoperatively]: Use of inotrops to support the cardiac output
• Complications [Intraoperatively and up to 72 hours postoperatively]: All perioperative complications

Sex: All

Inclusion Criteria:

All diabetic type 2 patients undergoing isolated on-pump coronary artery bypass surgery.

Exclusion Criteria:

* Missing data.
* Patients outside the study period.
* Patients undergoing other cardiac surgeries.
* Patients diagnosed with type 1 diabetes mellitus.

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• Mohammad B Izzat, FRCS(CTh), Study director, Damascus University