Cardiovascular Research Center, Rajaie Cardiovascular Institute, Tehran, IR Iran.
Abstract
Hyperglycemia in hospitalized patients presents a significant challenge, as it is linked to adverse clinical outcomes such as heightened infection risks, delayed wound healing, cardiovascular complications, and extended hospital stays. Research indicates that factors like underlying medical conditions, physiological stress, and certain medications contribute to elevated blood sugar levels in these patients. Additionally, transient insulin resistance worsens hyperglycemia in both diabetic and nondiabetic individuals, underscoring the need for meticulous management—especially in post-cardiac surgery settings, where complication risks are elevated. Although insulin resistance is a well-documented phenomenon, its occurrence in patients undergoing coronary artery bypass grafting (CABG) is relatively rare. This case study details the successful management of a 67-year-old woman with hypertension and hyperlipidemia but no prior history of diabetes, who developed insulin resistance following CABG. The article underscores the significance of recognizing insulin resistance and implementing appropriate postoperative interventions, highlighting the necessity for a tailored care strategy after CABG. (Iranian Heart Journal 2025; 26(2): 77-81)
Neshat S, Rezaei A, Farid A, Javanshir S, Niri FD, Daneii P, et al. Cardiovascular diseases risk predictors: ABO blood groups in a different role. Cardiology in Review. 2024; 32(2):174-9.
Liao P, DeSantis AJ, Schmeltz LR, Schmidt K, O'Shea-Mahler E, Victor S, Molitch ME. Insulin resistance following cardiothoracic surgery in patients with and without a preoperative diagnosis of type 2 diabetes during treatment with intravenous insulin therapy for postoperative hyperglycemia. Journal of Diabetes and its Complications. 2008; 22(4):229-34.
Fonseca VA. Management of diabetes mellitus and insulin resistance in patients with cardiovascular disease. The American journal of cardiology. 2003;92(4):50-60.
Aydin E, Ozkokeli M. Does Homeostasis Model Assessment of Insulin Resistance have a predictive value for post-coronary artery bypass grafting surgery outcomes? Brazilian Journal of Cardiovascular Surgery. 2014; 29:360-6.
Sumin AN, Bezdenezhnykh NA, Bezdenezhnykh AV, Osokina AV, Kuz’mina AA, Tsepokina AV, Barbarash OL. Screening for Glucose Metabolism Disorders, Assessment the Disse Insulin Resistance Index and Hospital Prognosis of Coronary Artery Bypass Surgery. Journal of Personalized Medicine. 2021; 11(8):802.
Strisciuglio T, Izzo R, Barbato E, Di Gioia G, Colaiori I, Fiordelisi A, et al. Insulin resistance predicts severity of coronary atherosclerotic disease in non-diabetic patients. Journal of Clinical Medicine. 2020; 9(7):2144.
An X, Yu D, Zhang R, Zhu J, Du R, Shi Y, Xiong X. Insulin resistance predicts progression of de novo atherosclerotic plaques in patients with coronary heart disease: a one-year follow-up study. Cardiovascular diabetology. 2012; 11(1):1-10.
Zhao X, An X, Yang C, Sun W, Ji H, Lian F. The crucial role and mechanism of insulin resistance in metabolic disease. Frontiers in Endocrinology. 2023; 14:1149239.
Bugianesi E, McCullough AJ, Marchesini G. Insulin resistance: a metabolic pathway to chronic liver disease. Hepatology. 2005; 42(5):987-1000.
Sumin AN, Bezdenezhnykh NA, Bezdenezhnykh AV, Osokina AV, Kuzmina AA, Sinitskaya AV, Barbarash OL. The role of insulin resistance in the development of complications after coronary artery bypass grafting in patients with coronary artery disease. Biomedicines. 2023; 11(11):2977.
Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006; 444(7121):860-7.
Wang Y-Y, Lin S-Y, Chuang Y-H, Chen C-J, Tung K-C, Sheu WH-H. Adipose proinflammatory cytokine expression through sympathetic system is associated with hyperglycemia and insulin resistance in a rat ischemic stroke model. American Journal of Physiology-Endocrinology And Metabolism. 2011; 300(1):E155-E63.
YOKOYAMA H, WASADA T, SHIMIZU Y, YOSHINO H, HASUMI S, OMORI Y. Transient extreme insulin resistance in shock during diabetic ketoacidosis. Endocrinologia japonica. 1992; 39(6):571-6.
Karrowni W, Li Y, Jones PG, Cresci S, Abdallah MS, Lanfear DE, et al. Insulin resistance is associated with significant clinical atherosclerosis in nondiabetic patients with acute myocardial infarction. Arteriosclerosis, thrombosis, and vascular biology. 2013; 33(9):2245-51.
Bennet AM, Brismar K, Hallqvist J, Reuterwall C, De Faire U. The risk of myocardial infarction is enhanced by a synergistic interaction between serum insulin and smoking. European journal of endocrinology. 2002; 147(5):641-7.
Ohta Y, Kinugawa S, Matsushima S, Ono T, Sobirin MA, Inoue N, et al. Oxidative stress impairs insulin signal in skeletal muscle and causes insulin resistance in postinfarct heart failure. American Journal of Physiology-Heart and Circulatory Physiology. 2011; 300(5):H1637-H44.
Zhang D-S, Liang G-Y, Liu D-X, Yu J, Wang F. Role of phosphorylated AMP-activated protein kinase (AMPK) in myocardial insulin resistance after myocardial ischemia-reperfusion during cardiopulmonary bypass surgery in dogs. Medical Science Monitor: International Medical Journal of Experimental and Clinical Research. 2019; 25:4149.
Ghanbari garekani,M. , Sadeghi,A. , Barakat,S. , Ghiasi,M. and Dayani,A. (2025). Insulin Resistance in a Nondiabetic Patient Aggravated After Coronary Artery Bypass Grafting: A Case Report. Iranian Heart Journal, 26(2), 77-81.
MLA
Ghanbari garekani,M. , , Sadeghi,A. , , Barakat,S. , , Ghiasi,M. , and Dayani,A. . "Insulin Resistance in a Nondiabetic Patient Aggravated After Coronary Artery Bypass Grafting: A Case Report", Iranian Heart Journal, 26, 2, 2025, 77-81.
HARVARD
Ghanbari garekani M., Sadeghi A., Barakat S., Ghiasi M., Dayani A. (2025). 'Insulin Resistance in a Nondiabetic Patient Aggravated After Coronary Artery Bypass Grafting: A Case Report', Iranian Heart Journal, 26(2), pp. 77-81.
CHICAGO
M. Ghanbari garekani, A. Sadeghi, S. Barakat, M. Ghiasi and A. Dayani, "Insulin Resistance in a Nondiabetic Patient Aggravated After Coronary Artery Bypass Grafting: A Case Report," Iranian Heart Journal, 26 2 (2025): 77-81,
VANCOUVER
Ghanbari garekani M., Sadeghi A., Barakat S., Ghiasi M., Dayani A. Insulin Resistance in a Nondiabetic Patient Aggravated After Coronary Artery Bypass Grafting: A Case Report. Iranian Heart Journal, 2025; 26(2): 77-81.
