Glucose-insulin-potassium solutions improve outcomes in diabetics who have coronary artery operations

Lazar, Harold L.; Chipkin, Stuart R.; Philippides, George J.; Bao, Yusheng; Apstein, Carl S.

doi:10.1016/s0003-4975(00)01317-5

Cited by 129 publications

(87 citation statements)

References 19 publications

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“…With this approach, it is possible to take advantage of the beneficial effects of B 2 R activation, while avoiding the nefarious consequences of upregulation and stimulation of the B 1 R. In fact, this approach could also be utilized in other conditions of myocardial ischemia, for example, surgical procedures, where preservation of myocardial tissue may be enhanced by optimizing glucose metabolism. One intervention that has recently been re-introduced to this aim is the 'GIK' treatment, that is, a controlled glucose-insulin-potassium infusion 81 that was shown to benefit diabetics with coronary artery disease undergoing cardiac surgery. A B 2 R agonist infused along with the GIK components would further enhance the benefits of this intervention by promoting optimal glucose utilization by cardiomyocytes, something particularly useful for patients with type II diabetes mellitus, who are already at higher risk of ischemic cardiac events and adverse long-term consequences of such events.…”

Section: B 2 R-mediated Cardioprotection Post Ischemic Injurymentioning

confidence: 99%

Cardioprotective properties of bradykinin: role of the B2 receptor

et al. 2010

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Following the introduction of angiotensin-converting enzyme (ACE) inhibitors in the treatment of hypertension and ischemic heart disease, there has been increasing interest in the bradykinin-mediated aspects of ACE inhibition. Several preclinical and clinical studies have been conducted using genetically engineered animals or pharmacological agonists and antagonists of the two receptors of bradykinin, B 1 R and B 2 R. The results have mostly indicated that the B 1 R, whose expression is induced by tissue damage, seem to have mostly noxious effects, whereas the constitutively expressed B 2 R, when activated, exert mostly beneficial actions. Accumulating evidence in the recent literature suggests that the B 2 R have an important role in the process of ischemic post-conditioning that limits the ischemia/reperfusion injury of the myocardium. In this article, we describe a series of experiments conducted on mice submitted to acute myocardial infarct and treated either with ACE inhibition (which produces potentiation of bradykinin resulting in non-selective B 1 R and B 2 R activation) or with a potent and highly selective B 2 R agonist. These data suggest that this latter pharmacological approach offers functional and structural benefits and is therefore a promising cardioprotective therapeutic modality against acute ischemic events. INTRODUCTIONThe possible role of bradykinin (BK) in cardiovascular regulation has intrigued scientists for many years. A member of the kinin system discovered in the late 1920s, BK is a nonapeptide whose existence was first recognized by Roha e Silva et al. 1 from its effects on intestinal smooth muscle. Since then, several other actions of BK were described, including vascular contraction and relaxation, participation in the process of inflammatory reactions, interaction with central and peripheral neural structures, stimulation of synthesis and release of various vasoactive substances, enhanced insulin-dependent glucose transport and utilization, etc.Circulatory homeostasis is the result of a constant equilibrium between vasoconstrictors (e.g., pressor neurohormonal factors like angiotensin II, catecholamines, vasopressin, endothelin) and vasodilators (like kinins, prostaglandins, NO, etc.). Bradykinin, a tissue hormone that regulates the regional blood flows of vital organs, is an important member of the latter group. 2 The role of BK in cardiovascular regulation under physiological and pathological conditions attracted the interest of clinicians with the advent of angiotensinconverting enzyme (ACE) inhibitors, which in the last two decades have become standard therapy for hypertension, ischemic heart disease and heart failure. 3 In recent years the work of many investigators has produced a lot of new information regarding the role of kinins in the pathophysiology of hypertension and the prevention of its end-organ complications.

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Section: B 2 R-mediated Cardioprotection Post Ischemic Injurymentioning

confidence: 99%

Cardioprotective properties of bradykinin: role of the B2 receptor

et al. 2010

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“…However, we and other have previously shown that both glucose-insulin-potassium (GIK) and glutamate can enhance the metabolic and functional recovery of the postischemic heart (40,49,(57)(58)(59)(60)(61)(62)(63). In contrast to inotropes the improvement in hemodynamic state is achieved without undue increase in myocardial oxygen demand.…”

Section: Metabolic Supportmentioning

confidence: 99%

A metabolic protective strategy could improve long-term survival in patients with LV-dysfunction undergoing CABG

Svedjeholm

Vidlund²,

Vanhanen

et al. 2010

Scandinavian Cardiovascular Journal

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Hemodynamic state was primarily assessed by mixed venous oxygen saturation (SvO 2 ).Follow-up averaged 9.7±1.4 years.Results LVEF was 0.30 ± 0.05 (range 0.20-0.37) and 3.5 ± 1.3 vessels were bypassed.Inotropes were used in 6.7% for weaning from CPB. Increase of s-creatinine by 50% compared to preoperative values was observed in 2.9 %. Logistic EuroSCORE was 8.3%whereas observed 30-day mortality was 1.0%. Crude 5-year survival was 89.4%. ConclusionsThe metabolic strategy allowed restrictive use of inotropes and was associated with encouraging long-term survival. Renal function was well preserved suggesting that SvO 2 served as an adequate marker of circulation. Randomized trials with metabolic support are warranted.

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“…Strict glycemic control has been demonstrated to be beneficial in other settings as well, with intravenous insulin in preference to the subcutaneous route in many clinical situations, including diabetic ketoacidosis and the nonketotic hyperosmolar state (2), critical care illness (1), myocardial infarction or cardiogenic shock (3)(4)(5), and the postoperative period after cardiac surgical procedures (6). Other indications for intravenous insulin infusion therapy include use in patients with diabetes who are receiving nothing by mouth, general perioperative care, total parental nutrition, or high-dose corticosteroid therapy; in patients who have had a stroke; in women during labor and delivery; as a dose-finding strategy in anticipation of initiation of subcutaneous insulin; and in prevention or treatment of infection.…”

mentioning

confidence: 99%

Glucommander

2005

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OBJECTIVE -Intravenous insulin is now the recommended method of diabetes management in critically ill persons in the hospital. The published methods for administering the insulin are complex and are usually limited to intensive care units with a low patient-to-nurse ratio. RESEARCH DESIGN AND METHODS-A computer-directed algorithm for advice on the delivery of intravenous insulin that is flexible in blood glucose timing and advises insulin dosing in a graduated manner has been developed. This software program, known as the Glucommander, has been used extensively by our group. The data were analyzed for this study.RESULTS -The data from 5,080 intravenous insulin runs over 120,683 h show that blood glucose levels can be safely stabilized in a target range without significant hypoglycemia by nonspecialized nurses working on any unit of a general hospital. The mean glucose level reached Ͻ150 mg/dl in 3 h. Only 0.6% of all glucose values were Ͻ50 mg/dl. The prevalence of hypoglycemia Ͻ40 mg/dl was 2.6% of all runs. No hypoglycemia was severe.CONCLUSIONS -This computer-directed algorithm is a simple, safe, effective, and robust method for maintaining glycemic control. It has been extensively studied and is applicable in a wide variety of conditions. In contrast to other published intravenous insulin protocols, which have been limited to intensive care units, Glucommander can be used in all units of any hospital. Diabetes Care 28:2418 -2423, 2005A large, randomized, controlled trial of patients admitted to a surgical intensive care unit in Leuven, Belgium, and reported by Van den Berghe et al. (1) showed that regulation of blood glucose levels to Ͻ110 mg/dl using an intravenous insulin protocol improved clinical outcomes. In the Leuven study, intensive insulin therapy reduced intensive care unit (ICU) mortality by 34% and also reduced sepsis, the need for dialysis, prolonged ventilator support, and the duration of ICU stay.Strict glycemic control has been demonstrated to be beneficial in other settings as well, with intravenous insulin in preference to the subcutaneous route in many clinical situations, including diabetic ketoacidosis and the nonketotic hyperosmolar state (2), critical care illness (1), myocardial infarction or cardiogenic shock (3-5), and the postoperative period after cardiac surgical procedures (6). Other indications for intravenous insulin infusion therapy include use in patients with diabetes who are receiving nothing by mouth, general perioperative care, total parental nutrition, or high-dose corticosteroid therapy; in patients who have had a stroke; in women during labor and delivery; as a dose-finding strategy in anticipation of initiation of subcutaneous insulin; and in prevention or treatment of infection.Based on the emerging clinical evidence, there are widespread efforts to maintain very strict glycemic control in critically ill patients. However, achieving this goal requires extensive nursing efforts, including frequent bedside capillary glucose monitoring and the implementation of compl...

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Glucose-insulin-potassium solutions improve outcomes in diabetics who have coronary artery operations

Cited by 129 publications

References 19 publications

Cardioprotective properties of bradykinin: role of the B2 receptor

Cardioprotective properties of bradykinin: role of the B2 receptor

A metabolic protective strategy could improve long-term survival in patients with LV-dysfunction undergoing CABG

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