Understanding Artificial Pancreas Systems: Results from a 24-Month Trial

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Open-label or unblinded (moderate): Open-label design

LVEF change from baseline was 6.2 percentage points higher in the observation group (95% CI 3.1 to 9.3; P<0.001).

At 6 months, the intervention group improved left ventricular ejection fraction more than routine care, which was the primary endpoint and the clearest cardiac benefit in the trial.

HbA1c change from baseline differed by -1.3% (95% CI -1.8 to -0.8; P<0.001; FDR-corrected q=0.002).

HbA1c improved more with structured case management than with routine care alone at 6 months, supporting a meaningful effect on diabetes control during recovery.

6-minute walk test change from baseline was 34 m greater in the observation group (95% CI 18 to 50; P=0.002).

Patients receiving structured case management walked farther at follow-up, suggesting better functional recovery after CABG.

LVESD change from baseline differed by -2.9 mm (95% CI -4.0 to -1.8; P<0.001).

The intervention group had a larger reduction in left ventricular end-systolic diameter, which supports improved cardiac remodeling.

LVEDD change from baseline differed by -3.1 mm (95% CI -4.2 to -2.0; P<0.001).

Left ventricular end-diastolic diameter improved more in the intervention group, suggesting more favorable cardiac remodeling during recovery.

Triglycerides change differed by -0.45 mmol/L (95% CI -0.62 to -0.28; P<0.001).

Triglycerides decreased more with structured case management, consistent with better metabolic recovery and dietary adherence.

Total cholesterol change differed by -0.6 mmol/L (95% CI -0.8 to -0.4; P<0.001).

Total cholesterol improved more in the intervention group over 6 months.

LDL-C change differed by -0.67 mmol/L (95% CI -0.93 to -0.41; P<0.001).

LDL cholesterol decreased more with the intervention, which supports a broader cardiometabolic benefit.

HDL-C change differed by 0.16 mmol/L (95% CI 0.10 to 0.22; P<0.001).

HDL cholesterol increased more in the intervention group at 6 months.

DSQL score at 6 months was 16.2 points higher in the observation group (95% CI 12.8 to 19.6; P<0.0001).

Diabetes-specific quality-of-life scores were substantially higher in the intervention group at 6 months.

ADL score at 6 months was 13.2 points higher in the observation group (95% CI 9.8 to 16.6; P<0.0001).

Daily living scores were higher in the intervention group, suggesting better functional independence after surgery.

Serious adverse events occurred in 4.8% of the observation group and 9.5% of the control group (RR 0.50, 95% CI 0.16 to 1.60; P=0.243).

Serious adverse events were numerically lower in the intervention group, but the trial did not show a clear between-group difference.

A multi-component care program combining individualized cardiac rehabilitation, modified Mediterranean diet support, psychological support, diabetes education, intensified monitoring, and structured follow-up after off-pump CABG.

Positive: 11; Negative: 0; No effect: 1; Mixed: 0

Direction counts recalculated from intervention outcomes due to mismatch with AI-provided counts.

Extracted 12 outcome signals across the study

The primary endpoint and multiple metabolic, functional, and patient-reported secondary outcomes all favored the intervention, while safety outcomes did not show a clear harm signal.

Direction counts were recalculated from extracted outcomes because the AI-provided totals did not match.

Structured case management ↑ left ventricular ejection fraction at 6 months

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

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

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

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.

Structured case management ↓ HbA1c, triglycerides, total cholesterol, and LDL cholesterol

Structured case management ↑ walking distance, quality of life, and daily living scores

The control group received routine nursing care and follow-up including standard education and monthly telephone follow-up.

Routine care

The observation group received routine care plus a 6-month multidisciplinary intervention including individualized cardiac rehabilitation, modified Mediterranean diet, psychological support, and intensified follow-up. Overall protocol adherence of at least 80% was achieved by 91.7% of intervention patients.

Structured multidisciplinary case management

Includes self-reported outcomes (moderate): Self-reported outcomes used

Limited population scope (moderate): Narrow population scope

No post-intervention follow-up (moderate): 0 weeks of follow-up after treatment ended

Open-label or unblinded study (moderate): Open-label design

Structured case management may improve recovery after CABG in older adults with type 2 diabetes

This trial tested a structured case management program in older adults with type 2 diabetes recovering from off-pump CABG. Compared with routine care alone, the program improved heart function, HbA1c, walking distance, lipid measures, and patient-reported recovery over 6 months.

The intervention was multi-component, so the study cannot isolate which component mattered most

Results came from one hospital and may not translate directly to community settings

Routine perioperative glucose control and antibiotic protocols were standardized in both groups

Some benefits were measured with patient-reported scales that may be more vulnerable to lack of blinding

A 6-month multidisciplinary case management program after off-pump CABG in older adults with type 2 diabetes

Structured case management may improve recovery after CABG in older adults with type 2 diabetes

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