Sitagliptin for prevention of stress hyperglycemia in patients without diabetes undergoing general surgery: A pilot randomized study

• Type of Material: Article
• Authors: Maya Fayfman, Emory University; Georgia Davis, Emory University; Elizabeth Duggan, Emory University; Maria Urrutia, Emory University; David Chachkhiani, Emory University; Joanna Schindler, Emory University; Francisco Pasquel, Emory University; Rodolfo Galindo, Emory University; Priyathama Vellanki, Emory University; David Reyes Umpierrez, Emory University; Heqiong Wang, Emory University; Guillermo Umpierrez, Emory University
• Language: English
• Date: 2018-12-01
• Publisher: ELSEVIER SCIENCE INC
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2018
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jdiacomp.2018.08.014
• Title of Journal or Parent Work: JOURNAL OF DIABETES AND ITS COMPLICATIONS
• Volume: 32
• Issue: 12
• Start Page: 1091
• End Page: 1096
• Grant/Funding Information: PV was supported in part by NIH-K12 has received consulting fees from Boehringer Ingelheim and Merck.; GEU has received unrestricted research support for inpatient studies (to Emory University) from Merck, Novo Nordisk, AstraZeneca, Boehringer Ingelheim, and Sanofi.; This work was supported by the Emory Medical Care Foundation Internal Grant (MF).; GEU is partly supported by research grants from the Public Health Service (grants UL1 RR025008 from the Clinical and Translational Science Award program and 1P30DK111024-01 from the National Institutes of Health and National Center for Research Resources).; FJP has received consulting fees from Boehringer Ingelheim, Sanofi, and Merck.
• Keywords: Inpatient; Perioperative management; Science & Technology; PERIOPERATIVE GLYCEMIC CONTROL; Life Sciences & Biomedicine; Hospital complications; ASSOCIATION; PHARMACOKINETICS; Stress hyperglycemia; MANAGEMENT; DPP4-inhibitors; MELLITUS; CARE; BYPASS SURGERY; OUTCOMES; Endocrinology & Metabolism; CARDIAC-SURGERY; MORTALITY
• Research Categories: Health Sciences, Medicine and Surgery; Health Sciences, Pharmacology

Abstract

Aim: We investigated if a dipeptidyl peptidase-4 inhibitor, sitagliptin, can prevent perioperative stress hyperglycemia in patients without prior history of diabetes mellitus undergoing general surgery. Methods: This double-blind pilot trial randomized general surgery patients to receive sitagliptin (n = 44) or placebo (n = 36) once daily, starting one day prior to surgery and continued during the hospital stay. The primary outcome was occurrence of stress hyperglycemia, defined by blood glucose (BG) >140 mg/dL and >180 mg/dL after surgery. Secondary outcomes included: length-of-stay, ICU transfers, hypoglycemia, and hospital complications. Results: BG >140 mg/dL was present in 44 (55%) of subjects following surgery. There were no differences in hyperglycemia between placebo and sitagliptin (56% vs. 55%, p = 0.93). BG >180 mg/dL was observed in 19% and 11% of patients treated with placebo and sitagliptin, respectively, p = 0.36. Both treatment groups had resulted in similar postoperative BG (148.9 ± 29.4 mg/dL vs. 146.9 ± 35.2 mg/dL, p = 0.73). There were no differences in length-of-stay (4 vs. 3 days, p = 0.84), ICU transfer (3% vs. 5%, p = 1.00), hypoglycemia <70 mg/dL (6% vs. 11%, p = 0.45), and complications (14% vs. 18%, p = 0.76). Conclusion: Preoperative treatment with sitagliptin did not prevent stress hyperglycemia or complications in individuals without diabetes undergoing surgery.