Liraglutide as an alternative to insulin for glycemic control in intensive care unit: A randomized, open-label, clinical study

Abstract

Background:Intravenous insulin is the cornerstone in the management of hyperglycemia in the Intensive Care Unit (ICU). We studied the efficacy of liraglutide compared with insulin in the ICU.Materials and Methods:In this prospective, open-labeled, randomized study, we included 120 patients (15–65 years, either sex) admitted to ICU with capillary blood glucose (CBG) between 181 and 300 mg/dl. We excluded patients with secondary diabetes and APACHE score >24. The patients were divided into two groups (n = 60) based on the CBG: Group 1 (181–240) and Group 2 (241–300). They were randomized further into four subgroups (n = 30) to receive insulin (Groups 1A and 2A), liraglutide (Group 1B), and insulin with liraglutide (Group 2B). The primary outcome was the ability to achieve CBG below 180 mg/dL at the end of 24 h. The secondary outcomes include mortality at 1 month and hospital stay. Data and results were analyzed using Mann-Whitney U-test, paired t- test, and Chi-square tests.Results:The mean age of the patients (93M and 27F) was 57.1 ± 13.9 years, hospital stay (16.9 ± 7.5 days), and CBG was 240.5 ± 36.2 mg/dl. The primary outcome was reached in 26, 27, 25, and 28 patients of Groups 1A, 2A, 1B, and 2B, respectively. The 30-day mortality and hospital stay were similar across all the four groups. Hypoglycemia was common with insulin and gastrointestinal side effects were more common with liraglutide (P < 0.001).Conclusion:Liraglutide is a viable alternative to insulin for glycemic control in the ICU. Further studies with a larger number of patients are required to confirm our findings.

Managing Diabetes in Patients Hospitalized in Internal Medicine Units

“… 15 A glucagon-like peptide-1 agonist has shown non-inferiority in glycemic control in intensive care unit (ICU) patients, most of which did not have preadmission diabetes, but an increase in nausea. 16 There are no specific studies on use of metformin, sodium-glucose cotransporter-2 inhibitors, pioglitazone, or acarbose in hospitalized patients, but experience shows that in selected patients they are safe to use. While in the past guidelines had recommended temporary interruption of metformin treatment before exposure to contrast media, most current guidelines recommend such interruption only in patients with chronic renal failure (with a cutoff of glomerular filtration rate of <60 or <45 mL/min per 1.73 m 2 ).…”

Retrospective Analysis of Hospitalized Patients with Type 2 Diabetes Mellitus Treated with Glucagon-Like Peptide 1 Receptor Agonist Therapy

“…6 Another study of hyperglycemic patients with DM in the intensive care unit found that liraglutide had an impact comparable to that of intravenous insulin for glucose control, less hypoglycemia, and more gastrointestinal adverse effects as compared with insulin treatment. 7 We are aware of only one study with noncritically ill inpatients with DM. This study found that mean daily blood glucose improved without significant adverse effects with the GLP-1 receptor agonist called exenatide plus bolus insulin as compared with treatment with exenatide alone.…”

“…One perioperative study of DM patients comparing liraglutide, insulin infusion, or subcutaneous insulin found that liraglutide was associated with the lowest glucose levels 6 . Another study of hyperglycemic patients with DM in the intensive care unit found that liraglutide had an impact comparable to that of intravenous insulin for glucose control, less hypoglycemia, and more gastrointestinal adverse effects as compared with insulin treatment 7 …”