Sitagliptin for the prevention and treatment of perioperative hyperglycaemia in patients with type 2 diabetes undergoing cardiac surgery: A randomized controlled trial

• Authors: Saumeth Cardona, Emory University; Katerina Tsegka, Emory University; Francisco Javier Pasquel, Emory University; Sol Jacobs, Emory University; Michael Halkos, Emory University; Brent Keeling, Emory University; Georgia Davis, Emory University; Maya Fayfman, Emory University; Bonnie Albury, Emory University; Maria Agustina Urrutia, Emory University; Rodolfo Galindo, Emory University; Alexandra Migdal, Emory University; Steven K. Macheers, Emory University; Robert Guyton, Emory University; Priyathama Vellanki, Emory University; Limin Peng, Emory University; Guillermo E. Umpierrez, Emory University
• Journal Title: Diabetes, Obesity and Metabolism
• Volume: Volume 23, Number 2
• Publisher: Wiley | 2021-02-01, Pages 480-488
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1111/dom.14241
• Subjects: Health Sciences, Medicine and Surgery
• Keywords: cardiac surgery; CABG; DPP-4 inhibitors; hyperglycaemia; stress

Abstract

Aim: To assess whether treatment with sitagliptin, starting before surgery and continued during the hospital stay, can prevent and reduce the severity of perioperative hyperglycaemia in patients with type 2 diabetes undergoing coronary artery bypass graft (CABG) surgery. Materials and Methods: We conducted a double-blinded, placebo-controlled trial in adults with type 2 diabetes randomly assigned to receive sitagliptin or matching placebo starting 1 day prior to surgery and continued during the hospital stay. The primary outcome was difference in the proportion of patients with postoperative hyperglycaemia (blood glucose [BG] > 10 mmol/L [>180 mg/dL]) in the intensive care unit (ICU). Secondary endpoints included differences in mean daily BG in the ICU and after transition to regular wards, hypoglycaemia, hospital complications, length of stay and need of insulin therapy. Results: We included 182 participants randomized to receive sitagliptin or placebo (91 per group, age 64 ± 9 years, HbA1c 7.6% ± 1.5% and diabetes duration 10 ± 9 years). There were no differences in the number of patients with postoperative BG greater than 10 mmol/L, mean daily BG in the ICU or after transition to regular wards, hypoglycaemia, hospital complications or length of stay. There were no differences in insulin requirements in the ICU; however, sitagliptin therapy was associated with lower mean daily insulin requirements (21.1 ± 18.4 vs. 32.5 ± 26.3 units, P = .007) after transition to a regular ward compared with placebo. Conclusion: The administration of sitagliptin prior to surgery and during the hospital stay did not prevent perioperative hyperglycaemia or complications after CABG. Sitagliptin therapy was associated with lower mean daily insulin requirements after transition to regular wards.