Improved Cardiac Function and Glycemic Control in Elderly Diabetic Patients Through Structured Case Management After CABG

Clinical Snapshot

Key Findings

• P Value: P<0.001 for primary outcome

• Effect Size: Mean difference of 6.2% improvement in LVEF

• Primary Outcome: Left ventricular ejection fraction at 6 months significantly higher in intervention group

• Nnt Or Sensitivity: Not calculable from available data

• Confidence Interval: Not reported

Clinical Application

Requires multidisciplinary team coordination including cardiac rehabilitation, dietitians, and psychological support services Aligns with RACGP diabetes management guidelines and cardiac rehabilitation recommendations; intervention components available through Medicare and private health systems Elderly Australian patients with diabetes undergoing CABG surgery, particularly those at high risk of poor recovery

Abstract

BACKGROUND Elderly patients with both coronary heart disease (CHD) and diabetes mellitus (DM) undergoing off-pump coronary artery bypass grafting (CABG) face high risks of perioperative glucose fluctuations and impaired recovery. We evaluated the impact of a structured, multidisciplinary case management model on cardiac function and glycemic control in this population. MATERIAL AND METHODS This single-center, randomized controlled trial enrolled 168 elderly (≥65 years) patients with CHD and type 2 DM scheduled for off-pump CABG. Patients were randomized (1: 1) to a control group (CG, n=84; routine care) or an observation group (OG, n=84). The OG received routine care plus a 6-month multidisciplinary intervention including individualized cardiac rehabilitation, modified Mediterranean diet, psychological support, and intensified follow-up. The primary endpoint was 6-month left ventricular ejection fraction (LVEF); HbA1c was a key secondary endpoint. RESULTS All 168 randomized patients were analyzed. At 6 months, the observation group demonstrated significantly superior primary outcomes. LVEF was significantly higher in the OG (mean difference: 6.2%, P<0.001), and HbA1c was significantly lower (mean difference: 1.3%, P<0.001). The intervention group also showed significant improvements in secondary endpoints, including reduced left ventricular diameters (LVESD, LVEDD), an improved lipid profile (P<0.05), longer 6-minute walk test distance, and higher Diabetes-Specific Quality of Life (DSQL) and Activity of Daily Living (ADL) scores (P<0.0001). CONCLUSIONS Structured, multidisciplinary case management significantly improved cardiac function, metabolic control, and functional capacity in elderly diabetic patients after off-pump CABG, validating its efficacy for this high-risk group.

References

1. 1.Zhai, W., Yu, H., Li, Y., Zhang, L., & Li, Q. (2026). Improved cardiac function and glycemic control in elderly diabetic patients through structured case management after CABG. Medical Science Monitor, 32, Article 952109. https://doi.org/10.12659/MSM.952109