| BackgroundWith the development of economy and improvement of people’s living standards,the disease spectrum in China is constantly changing.Chronic non-communicable diseases are becoming the primary threat to public health.Among them,the prevalence of CAD(coronary artery disease)and T2DM(type 2 diabetes mellitus)has been increasing in recent years and gradually become the main burden of public health in China.CAD is one of the most important macrovascular complications of T2DM patients.At the same time,patients with T2DM tend to have more severe coronary lesions,and CABG(coronary artery bypass grafting)is recommended for revascularization compare to PCI(percutaneous coronary intervention).Patients with CAD and T2DM undergoing CABG are a huge population that cannot be ignored.Based on this patient group,this paper explored the intervention strategies and potential risk factors from three endpoints of secondary prevention,graft patency,and ventricular systolic function.Section 1Poor glycemic control is proofed to be associated with poor prognosis of patients with CAD.In order to improve the glycemic management of patients with CAD and T2DM underwent CABG,a customized intelligent mHealth(mobile health)intervention tool was designed and developed.The mHealth intervention was supposed to help patients with self-management through health education,medication reminders and other functions.A two-arm,multicenter RCT(randomized controlled clinical trial)was implemented to verify the effectiveness of intervention tool.By minimizing randomization,the enrolled patients were divided into two groups.Patients in the intervention group used mHealth intervention tool after surgery,and patients in the control group only received traditional health education before discharge.The results of HbA1C(Hemoglobin A1C)and other indicators were obtained 6 months after the operation,and the effectiveness of the intervention tool was evaluated by comparing the changes in outcomes between the two groups.We found that patients who received the intervention had significantly greater reductions in HbA1C 6 months after surgery.Our intervention had played a positive role in improving the glycemic management level of patients after CABG.Section 2As the key of CABG revascularization treatment,the graft vessel is of great significance to maintain its long-term patency.Diabetes and high blood glucose can promote vascular lesions,but its effect on graft vessel after CABG is still unclear.In order to clarify the association between long-term glycemic control and the occlusion of graft vessels,a retrospective study was conducted based on the database established in the Section 1.The glycemic control was quantified by HbA1C obtained preoperatively and 6 months postoperatively.The association between glycemic level and the patency rate of graft vessels after CABG was explored.We found that neither the preoperative and postoperative level of glycemic control show any connection to the rate of graft patency up to 1 year after CABG.Section 3The blood supply of the ischemic myocardium is restored after CABG,and its function can be recovered to a certain extent.However,related studies have found that the change of EF(ejection fraction)after CABG does not show an overall upward trend.Both T2DM and ID(iron deficiency)are found to affect the myocardial function of patients.A retrospective analysis based on the database of the Section 1 to identify the influence of glycemic level and ID on the recovery of EF after CABG.The results of the analysis showed that ID was an independent risk factor against the recovery of EF postoperatively after adjusted possible confounding factors.And no association was observed between the glycemic level and the increase of EF.ID should be taken more seriously as a risk factor among patients scheduled for CABG. |
