Structured case management may improve recovery after CABG in older adults with type 2 diabetes
Key takeaway:
In a 6-month randomized trial of 168 elderly patients with type 2 diabetes after off-pump CABG, structured multidisciplinary case management improved cardiac function, HbA1c, walking distance, lipids, and quality-of-life outcomes versus routine care.
Study at a glance
What was studied
A 6-month multidisciplinary case management program after off-pump CABG in older adults with type 2 diabetes
Study type
Randomized Controlled Trials (RCTs)
duration
Medium-Term (3–12 mo)
Intervention
Multidisciplinary case management program
Outcomes
Left ventricular ejection fraction (LVEF), HbA1c, 6-minute walk distance, Left ventricular systolic diameter, Left ventricular end-diastolic diameter, Triglycerides, Total cholesterol, LDL cholesterol, HDL cholesterol, Quality of life, Activities of daily living, Serious adverse events incidence
Funding
Non-industry sponsored
Main effects
Structured case management ↑ left ventricular ejection fraction at 6 months
Structured case management ↓ HbA1c, triglycerides, total cholesterol, and LDL cholesterol
Structured case management ↑ walking distance, quality of life, and daily living scores
Evidence Summary
| Intervention | Outcome | Measured Change | Study Effect |
|---|---|---|---|
 Structured multidisciplinary case management (Behavioral & Lifestyle) |  6-minute walk distance (Clinical Outcomes) | Increase | Strong |
Structured multidisciplinary case management (Behavioral & Lifestyle) |  Activities of daily living (Patient-Reported) | Increase | Strong |
Structured multidisciplinary case management (Behavioral & Lifestyle) |  HbA1c (Glycemic Control) | Decrease | Strong |
Structured multidisciplinary case management (Behavioral & Lifestyle) |  HDL cholesterol (Metabolic Health) | Increase | Strong |
Structured multidisciplinary case management (Behavioral & Lifestyle) | LDL cholesterol (Metabolic Health) | Decrease | Strong |
Structured multidisciplinary case management (Behavioral & Lifestyle) | Left ventricular ejection fraction (LVEF) (Metabolic Health) | Increase | Strong |
Structured multidisciplinary case management (Behavioral & Lifestyle) | Left ventricular end-diastolic diameter (Metabolic Health) | Decrease | Strong |
Structured multidisciplinary case management (Behavioral & Lifestyle) | Left ventricular end-systolic diameter (Metabolic Health) | Decrease | Strong |
Structured multidisciplinary case management (Behavioral & Lifestyle) | Quality of life (Patient-Reported) | Increase | Strong |
Structured multidisciplinary case management (Behavioral & Lifestyle) |  Serious adverse events incidence (Safety) | Decrease | Limited |
Structured multidisciplinary case management (Behavioral & Lifestyle) | Total cholesterol (Metabolic Health) | Decrease | Strong |
Structured multidisciplinary case management (Behavioral & Lifestyle) | Triglycerides (Metabolic Health) | Decrease | Strong |
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Evidence Suggest
- The primary endpoint, LVEF change, improved by 6.2 percentage points versus routine care
- HbA1c improved by 1.3 percentage points and multiple lipid outcomes also favored the intervention
- Functional and patient-reported recovery outcomes improved while serious adverse events were similar between groups
Who this applies to
Older adults aged 65 years or above
Keep in Mind
The intervention was multi-component, so the study cannot isolate which component mattered most
Between the Lines
- Single-center study in a tertiary hospital in Tianjin
- Participants and care teams were not blinded to the intervention
- The population was selected as relatively low-risk for rehabilitation, which may limit generalizability
- Follow-up lasted 6 months, so longer-term cardiovascular outcomes remain uncertain
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Journal Reference
Zhai W, Yu H, Li Y, Zhang L, Li Q. Improved cardiac function and glycemic control in elderly diabetic patients through structured case management after CABG. Med Sci Monit. 2026;32:e952109. doi:10.12659/MSM.952109
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