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

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.

Individual dipeptidyl peptidase‐4 inhibitors and acute kidney injury in patients with type 2 diabetes: A systematic review and network meta‐analysis

“…That study included only patients undergoing coronary artery bypass grafting who received sitagliptin for up to 10 days, starting from the day before surgery until discharge from the hospital and assessed adverse events for a period of 30 days. 17 The frequency of AKI was reported to be higher in the sitagliptin group than in the placebo group (57% vs. 34%) in this highly heterogeneous population. A post-hoc sensitivity analysis excluding this study showed that none of the individual DPP-4 inhibitors increased the risk of AKI in comparison with the placebo.…”

“…et al 17 which had significant outliers in the funnel plot. Analysis of the remaining 28 studies that included 56 036 participants with 828 AKIs (1.47%) found no statistically significant differences in the frequency of AKI between any of the DPP-4 inhibitors and placebo (Figure 3).…”

“…However, one study reported significant outliers in the funnel plot, indicating reporting bias, with large RRs and standard errors. 17…”

Chiral Luminescent Sensor Eu-BTB@d-Carnitine Applied in the Highly Effective Ratiometric Sensing of Curing Drugs and Biomarkers for Diabetes and Hypertension

“…Exogenous insulin is mainly used to treat diabetes. Sitagliptin is a new type of hypoglycemic agent, which can improve the body’s own ability to reduce excessive blood sugar levels . By inhibiting the enzyme activity, it can relatively increase naturally occurring incretin, including glucagon-like peptide-1 and glucose dependence. , Excess insulin can decrease the concentration of blood sugar.…”

Position statement: surgery and diabetes mellitus (Update 2023)

“…Eine andere randomisierte Studie zeigte bei Patient:innen ohne Diabetes mit allgemeinchirurgischen Operationen, dass postoperative Stresshyperglykämie nicht durch Therapie mit Sitagliptin vermieden werden konnte [ 107 ]. Ähnliche Ergebnisse zeigte eine verblindete placebo-kontrollierte Studie mit Sitagliptin bei Menschen mit DMT2 und kardiochirurgischen Eingriffen: Postoperative Hyperglykämie konnte in diesem Kollektiv nicht reduziert werden [ 108 ]. In der prospektiven randomisierten Sita-Hospital Untersuchung konnte für Sitapliptin plus Basalinsulin keine Unterlegenheit hinsichtlich der glykämischen Kontrolle im Vergleich zu Basis-Bolus-Therapie bei DMT2 gezeigt werden [ 109 ].…”