Clinical Effectiveness of Intravenous Exenatide Infusion in Perioperative Glycemic Control after Coronary Artery Bypass Graft Surgery

Abstract

Background We aimed to assess the clinical effectiveness of intravenous exenatide compared to insulin in perioperative blood glucose control in coronary artery bypass grafting surgery patients. Methods Patients more than 18 yr old admitted for elective coronary artery bypass grafting were included in a phase II/III nonblinded randomized superiority trial. Current insulin use and creatinine clearance of less than 60 ml/min were exclusion criteria. Two groups were compared: the exenatide group, receiving exenatide (1-h bolus of 0.05 µg/min followed by a constant infusion of 0.025 µg/min), and the control group, receiving insulin therapy. The blood glucose target range was 100 to 139 mg/dl. The primary outcome was the proportion of patients who spent at least 50% of the study period within the target range. The consumption of insulin (Cinsulin) and the time to start insulin (Tinsulin) were compared between the two groups. Results In total, 53 and 51 patients were included and analyzed in the exenatide and control groups, respectively (age: 70 ± 9 vs. 68 ± 11 yr; diabetes mellitus: 12 [23%] vs. 10 [20%]). The primary outcome was observed in 38 (72%) patients in the exenatide group and in 41 (80%) patients in the control group (odds ratio [95% CI] = 0.85 [0.34 to 2.11]; P = 0.30). Cinsulin was significantly lower (60 [40 to 80] vs. 92 [63 to 121] U, P < 0.001), and Tinsulin was significantly longer (12 [7 to 16] vs. 7 [5 to 10] h, P = 0.02) in the exenatide group. Conclusions Exenatide alone at the dose used was not enough to achieve adequate blood glucose control in coronary artery bypass grafting patients, but it reduces overall consumption of insulin and increases the time to initiation of insulin.

Effects of Liraglutide on Myocardial Function After Cardiac Surgery: A Secondary Analysis of the Randomised Controlled GLOBE Trial

“…Another difference with previous studies is the type of GLP-1 RA studied. While we performed the first randomised trial using liraglutide in patients undergoing cardiac surgery [2], Besch et al randomised patients undergoing CABG to either a continuous exenatide infusion or insulin for glycaemic control [16]. Similar to our present study, the authors performed an analysis of cardiac outcomes and found no difference in postoperative troponin levels nor in the incidence of reduced left ventricular ejection fraction between treatment and control groups [17].…”

A Randomized Controlled Trial on the Safety and Efficacy of Exenatide Therapy for the Inpatient Management of General Medicine and Surgery Patients With Type 2 Diabetes

“…In addition, increasing evidence indicates that incretin therapies have cardiovascular benefits, including reduced inflammation and oxidative stress (30,32) and improved endothelial function (24), which could benefit hospitalized patients with diabetes. Previous studies have reported on the use of native GLP-1 and GLP1-RA infusions in critically ill and surgical patients (33)(34)(35). Besch et al (34) compared the use of intravenous exenatide to insulin infusion in cardiac surgery patients and reported similar glycemic control and reduced insulin use in the ICU with exenatide therapy.…”

“…Previous studies have reported on the use of native GLP-1 and GLP1-RA infusions in critically ill and surgical patients (33)(34)(35). Besch et al (34) compared the use of intravenous exenatide to insulin infusion in cardiac surgery patients and reported similar glycemic control and reduced insulin use in the ICU with exenatide therapy. Perioperative treatment with a GLP1-RA, liraglutide, given subcutaneously prior to noncardiac surgery was studied by Polderman et al (35), who demonstrated improved glycemic control with liraglutide lowering insulin requirements.…”

Liraglutide for perioperative management of hyperglycaemia in cardiac surgery patients: a multicentre randomized superiority trial

“…The first trials studying a continuous infusion of GLP1 in cardiac surgery patients all found either lower BG concentrations or fewer insulin requirements with comparable glycaemic control. [14][15][16] While three trials studied a GLP1RA in cardiac surgery, [17][18][19] all used the short-acting GLP1RA exenatide, and only two 17,18 reported on BG concentrations or insulin requirements. One of these studies, including 38 patients, reported lower average BG concentrations with a trend towards fewer insulin requirements.…”

“…18 However, the other trial, including 104 patients, showed no difference in the number of patients requiring any insulin, total insulin dose or glycaemic control, although this study used a slightly higher dose of exenatide. 17 A trial comparing exenatide once weekly to liraglutide once daily in patients with type 2 diabetes mellitus found liraglutide to be more effective for improvement of glycaemic control and reduction of body weight. 20 However, liraglutide resulted in higher rates of nausea and vomiting at initiation of therapy, with differences dissolving after 4-6 weeks.…”