Sitagliptin for the prevention of stress hyperglycemia in patients without diabetes undergoing coronary artery bypass graft (CABG) surgery

• Type of Material: Article
• Authors: Saumeth Cardona, Emory University; Katerina Tsegka, Emory University; Francisco Javier Pasquel, Emory University; Maya Fayfman, Emory University; Limin Peng, Emory University; Sol Jacobs, Emory University; Priyathama Vellanki, Emory University; Michael Halkos, Emory University; Robert A Guyton, Emory University; Vinod Thourani, Emory University; Rodolfo Galindo, Emory University; Guillermo Umpierrez, Emory University
• Language: English
• Date: 2019-08-01
• Publisher: BMJ Publishing Group: Open Access
• Publication Version: Final Published Version
• Copyright Statement: © Author(s) (or their employer(s)) 2019. Published by BMJ.
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1136/bmjdrc-2019-000703
• Title of Journal or Parent Work: BMJ Open Diabetes Research and Care
• ISSN: 2052-4897
• Volume: 7
• Issue: 1
• Start Page: e000703
• End Page: e000703
• Grant/Funding Information: GU is partly supported by research grants from the NIH/NATS (UL1 TR002378) from the Clinical and Translational Science Award program; and from NIH and National Center for Research Resources (1P30DK111024-01).; This investigator-initiated study was supported by a clinical research grant from the Jacobs Research Foundation and Merck who provided sitagliptin and placebo medications.; FJP and PV are supported by NIH grants 1K23GM128221-01A1 and 3K12HD085850-03S1 respectively.
• Keywords: stress hyperglycemia; DPP-4 inhibitors; CABG
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Biostatistics

Abstract

Aims: To determine if treatment with sitagliptin, a dipeptidyl peptidase-4 inhibitor, can prevent stress hyperglycemia in patients without diabetes undergoing coronary artery bypass graft (CABG) surgery. Methods: We conducted a pilot, double-blinded, placebo-controlled randomized trial in adults (18-80 years) without history of diabetes. Participants received sitagliptin or placebo once daily, starting the day prior to surgery and continued for up to 10 days. Primary outcome was differences in the frequency of stress hyperglycemia (blood glucose (BG) >180 mg/dL) after surgery among groups. Results: We randomized 32 participants to receive sitagliptin and 28 to placebo (mean age 64±10 years and HbA1c: 5.6%±0.5%). Treatment with sitagliptin resulted in lower BG levels prior to surgery (101±mg/dL vs 107±13 mg/dL, p=0.01); however, there were no differences in the mean BG concentration, proportion of patients who developed stress hyperglycemia (21% vs 22%, p>0.99), length of hospital stay, rate of perioperative complications and need for insulin therapy in the intensive care unit or during the hospital stay. Conclusion: The use of sitagliptin during the perioperative period did not prevent the development of stress hyperglycemia or need for insulin therapy in patients without diabetes undergoing CABG surgery.