Clinical Alert: Bypass Over Angioplasty for Patients with Diabetes
In this article
The National Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of Health, today announced that, as a first revascularization procedure, coronary artery bypass graft (CABG) surgery has been shown to have a markedly lower 5-year death rate than angioplasty for persons with diabetes mellitus (Type I or II) who are on oral hypoglycemic agents or insulin.
The finding came from the NHLBI-funded Bypass Angioplasty Revascularization Investigation (BARI). The multicenter, international, randomized trial studied patients who needed a first revascularization because of severe ischemia with obstructions in two or more major coronary arteries. Over 5 years, patients with diabetes mellitus who were on drug therapy had a significantly lower (p=0.002) mortality rate with CABG, compared with percutaneous transluminal coronary angioplasty (PTCA). The 5-year CABG mortality rate was 19 percent, compared with 35 percent for PTCA. By contrast, in patients without diabetes and in those with diabetes but not on drug treatment, the 5-year mortality rates for CABG and PTCA were both about 9 percent.
Diabetes is a lifelong companion. Sometimes a complication like diabetic nerve pain takes time to resolve, and you may want to try different treatments and medications before finding one that works for you.
First, make sure you're doing the best job you can of controlling your blood sugar, exercising regularly, and keeping your weight normal. If you still have pain, numbness, or discomfort in your feet or hands (called peripheral neuropathy), you may need to turn to medications to soothe your nerve...
The higher death rate for PTCA was not due to complications of the procedure itself. Those with diabetes are known to have an excessive cardiovascular risk and a higher mortality rate was expected for them, regardless of revascularization procedure. However, the excess mortality with PTCA had not been anticipated.
BARI's results indicate that CABG should be the preferred treatment for patients with diabetes on drug or insulin therapy who have multivessel coronary artery disease and need a first coronary revascularization. These results have a significant impact on the clinical care of these patients.
Coronary revascularization plays an important role in the treatment of clinically severe coronary artery disease. The two most commonly used methods of revascularization are CABG and PTCA. PTCA is a catheter-based nonsurgical approach that directly targets coronary obstructions by dilation of the vessel at the point of obstruction. The process is accompanied by local vascular injury and subsequent healing. The extent of injury and the healing process may be different in diabetic and nondiabetic patients. Not all lesions can be dilated, due largely to technical reasons. CABG is a major operation, requiring opening of the chest. It provides a new channel, with a lumen frequently larger than the native, diseased lumen. There is no instrumentation of the local lesion and, therefore, no related vascular injury. While both treatments alleviate the effects of coronary artery disease, they do not correct or alter the natural course of the disease.
Get the latest Diabetes newsletter delivered to your inbox!
Your level is currently
If the level is below 70 or you are experiencing symptoms such as shaking, sweating or difficulty thinking, you will need to raise the number immediately. A quick solution is to eat a few pieces of hard candy or 1 tablespoon of sugar or honey. Recheck your numbers again in 15 minutes to see if the number has gone up. If not, repeat the steps above or call your doctor.
People who experience hypoglycemia several times in a week should call their health care provider. It's important to monitor your levels each day so you can make sure your numbers are within the range. If you are pregnant always consult with your health care provider.
Congratulations on taking steps to manage your health.
However, it's important to continue to track your numbers so that you can make lifestyle changes if needed. If you are pregnant always consult with your physician.
Your level is high if this reading was taken before eating. Aim for 70-130 before meals and less than 180 two hours after meals.
Even if your number is high, it's not too late for you to take control of your health and lower your blood sugar.
One of the first steps is to monitor your levels each day. If you are pregnant always consult with your physician.
Thank you for signing up for the WebMD Diabetes Newsletter!
You'll find tips and tricks as well as the latest news and research on Diabetes.
Did You Know Your Lifestyle Choices
Affect Your Blood Sugar?
Use the Blood Glucose Tracker to monitor
how well you manage your blood sugar over time.