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

• 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
• Journal Title: BMJ Open Diabetes Research and Care
• Volume: Volume 7, Number 1
• Publisher: BMJ Publishing Group: Open Access | 2019-08-01, Pages e000703-e000703
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1136/bmjdrc-2019-000703
• Subjects: Health Sciences, Medicine and Surgery; Biology, Biostatistics
• Keywords: CABG; DPP-4 inhibitors; stress hyperglycemia

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.