Metformin as an adjunct to insulin for glycemic control in patients with type 2 diabetes after CABG surgery: a randomized double blind clinical trial.

Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing Coronary Artery Bypass Graft (CABG) surgery and there is a direct relation between postoperative hyperglycemia and mortality rate in these patients. The aim of the present study is to determine the efficacy of metformin on glycemic control in diabetic patients after CABG surgery. In a randomized double blind clinical trial, 100 patients with type 2 diabetes admitted in open heart ICU after CABG surgery in Mazandaran Heart Center were enrolled. They were randomly assigned to two intervention and control groups. Three hours after extubation, therapeutic antiglycemic regimens were applied in these two groups and continued for three days. Intervention group received regular insulin infusion along with two metformin 500 mg tablets per twelve hours while control group received regular insulin infusion with two placebo tablets per twelve hours. Blood glucose level and other parameters were measured and recorded in determined intervals. To analyze the data, independent T-test, paired T-test, Mann-Whitney and repeated measure ANOVA tests were employed. Mean blood glucose level was not significantly different in the two groups at the beginning of the ICU admission; however, mean glucose level in insulin-metformin group, twelve hours after the initiation of the study, was significantly lower than insulin group (p < 0.05). In addition, mean doses of potassium and insulin demand as well as mean number of episodes of hyperglycemia, hypoglycemia and glucose levels out of the accepted range were significantly lower in insulin-metformin group (p < 0.05). Alterations in mean levels of lactate, BE, pH and creatinine were not statistically significant in these two groups. It seems that adding metformin to insulin leads to a better glycemic control in type two diabetic patients undergoing CABG surgery without causing metabolic acidosis. Therefore, it might be a potential option in blood glucose control protocol in this group of patients.