Abstract
Aims: Most cardiac surgery patients, with or without diabetes, develop perioperative hyperglycaemia, for which intravenous insulin is the only therapeutic option. This is labour-intensive and carries a risk of hypoglycaemia. We hypothesized that preoperative administration of the glucagon-like peptide-1 receptor agonist liraglutide reduces the number of patients requiring insulin for glycaemic control during cardiac surgery. Materials and methods: In this randomized, blinded, placebo-controlled, parallel-group, balanced (1:1), multicentre randomized, superiority trial, adult patients undergoing cardiac surgery in four Dutch tertiary hospitals were randomized to receive 0.6 mg subcutaneous liraglutide on the evening before surgery and 1.2 mg after induction of anaesthesia or matching placebo. Blood glucose was measured hourly and controlled using an insulin-bolus algorithm. The primary outcome was insulin administration for blood glucose >8.0 mmol/L in the operating theatre. Research pharmacists used centralized, stratified, variable-block, randomization software. Patients, care providers and study personnel were blinded to treatment allocation. Results: Between June 2017 and August 2018, 278 patients were randomized to liraglutide (139) or placebo (139). All patients receiving at least one study drug injection were included in the intention-to-treat analyses (129 in the liraglutide group, 132 in the placebo group). In the liraglutide group, 55 (43%) patients required additional insulin compared with 80 (61%) in the placebo group and absolute difference 18% (95% confidence interval 5.9–30.0, P = 0.003). Dose and number of insulin injections and mean blood glucose were all significantly lower in the liraglutide group. We observed no difference in the incidence of hypoglycaemia, nausea and vomiting, mortality or postoperative complications. Conclusions: Preoperative liraglutide, compared with placebo, reduces insulin requirements while improving perioperative glycaemic control during cardiac surgery.
| Original language | English |
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| Pages (from-to) | 557-565 |
| Number of pages | 9 |
| Journal | Diabetes, Obesity and Metabolism |
| Volume | 22 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - Apr 2020 |
| Externally published | Yes |
Funding
This investigator‐initiated study was partly supported by a research grant from the Investigator‐Initiated Studies Program of Novo Nordisk (Bagsvaerd, Denmark). M.J.V., M.B.G., B.T., M.B.G., T.S. and M.G.W. have no conflicts to declare. A.H.H. and J.H. have received a grant from the European Society of Anaesthesiology. R.A.B. acts as a consultant for Philips Research. M.W.H. is Executive Section Editor Pharmacology with , Section Editor Anesthesiology with and acts as a consultant for Eurocept, MSD and CSL Behring. B.P. has received research support from GE Healthcare, Edwards, Air Liquide; he has received lecture fees from Abbott, Abbvie, Orion Pharma, Philips Healthcare and grants from SCA, ESA and ZonMW. J.H.D. has received research support from Sanofi, acts as a consultant for Novo Nordisk. As the funder of the study, Novo Nordisk, had no role in study design, data collection, data analysis, data interpretation or writing of the report. The corresponding author had full access to all the data in the study and had final responsibility for the decision to submit. Anesthesia & Analgesia Journal of Clinical Medicine
| Funders |
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| Society for Cultural Anthropology |
| European Space Agency |
| ZonMw : Dutch Organisation for Health Research and Development |
| European Society of Anaesthesiology |
