Abstract
Introduction
Sodium-glucose cotransporter 2 inhibitors (SGLT2-I), a commonly prescribed antihyperglycemic agent for patients with type 2 diabetes mellitus (T2DM), have proven efficacy in managing T2DM and its common cardiovascular comorbidities. The increased risk of coronary artery disease in T2DM patients makes them more likely candidates for coronary artery bypass graft (CABG) surgery. SGLT2-I improve long-term cardiovascular outcomes, but evidence of their effects in the immediate post-op period is limited.
Methods
We collected medical records of patients with T2DM who underwent CABG surgery (N = 765) from 2019 to 2025 at our hospital from the EPIC system. Of the population studied, patients who received dapagliflozin (N = 166) during their hospital stay were compared to those who did not receive this drug (N = 599). Patients with prior use of any SGLT2-I were included, but only dapagliflozin use was studied due to formulary restrictions in our hospital. We performed Chi-square, t-tests, and logistic regression to investigate relationships between inpatient SGLT2-I use and baseline characteristics, insulin requirements, mean glucose values, occurrence of arrhythmias, 90-day readmission rates, and post-op mortality.
Results
The average age of the population was 64 years, with a majority being male (n=557), White (n=506), and an average BMI of 31.3 kg/m2. Of 765 patients, 97% received insulin during their hospitalization; 22% received dapagliflozin with mean initiation on post-op day 3. Among variables studied, several showed statistically significant association with SGLT2-I use, including BMI, baseline creatinine, glargine and lispro insulin dosing (on the day before discharge), heart failure with preserved ejection fraction (HFpEF), and 90-day readmissions (all p 0.05). In the multivariable logistic regression model, only HFpEF and baseline creatinine remained significantly associated with dapagliflozin use after adjusting for covariates. Patients with HFpEF had significantly lower odds of receiving dapagliflozin (OR 0.48, p = 0.0458). Treatment with dapagliflozin did not affect mean glucose values, total and ICU lengths of stay, occurrence of major arrhythmia during admission, 90-day readmission rates, or post-op mortality.
Conclusion
Our study showed that patients who received dapagliflozin during their hospital stay for CABG surgery required lower basal and bolus insulin doses at discharge compared to those who did not receive dapagliflozin. On average, dapagliflozin was initiated 3 days after surgery. While patients with HFpEF were less likely to receive this drug in our study, further studies are required in this specific population post-CABG surgery.