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

Abstract

AimsTo 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.MethodsWe 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.ResultsWe 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.ConclusionThe 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.

Stress Hyperglycemia Is Independently Associated with Persistent Organ Failure in Acute Pancreatitis

“…Actually, stress hyperglycemia was usually found in patients without known pre-existing DM, and there is no agreed definition of stress hyperglycemia in different acute and critical illnesses [8,37]. Dungan et al defined stress hyperglycemia as fasting plasma glucose levels ≥ 126 mg/dl for non-diabetic patients [8], and the definition varies in different studies, such as myocardial infarction (≥ 110, ≥ 120, ≥ 140, ≥ 144, ≥ 180, or ≥ 200 mg/dl) [9,38], surgery (≥ 140 or ≥ 180 mg/ dl) [11,[39][40][41] and critical illness (≥ 126 or ≥ 200 mg/dl) [42,43]. In our study, we defined stress hyperglycemia for non-diabetic patients as ≥ 126, ≥ 140, ≥ 180, and ≥ 200 mg/ dl, and selected a cut-off BG level of ≥ 180 mg/dl to provide a better definition according to multivariate logistic regression and ROC curves.…”

Hypoglycemic Agents and Anesthetic Techniques to Ameliorate Stress Hyperglycemia in Critically Ill Patients: A Systematic Review

“…Two studies evaluated the effects of preoperative administration of sitagliptin on glycemic control. [ 47 48 ] The results indicated that sitagliptin was not potent enough to prevent stress hyperglycemia response in patients scheduled for surgery. The systemic immunological and metabolic responses induced by surgery and the fasting status before the procedure might have contributed to these outcomes.…”

Preoperative Management of Endocrine, Hormonal, and Urologic Medications: Society for Perioperative Assessment and Quality Improvement (SPAQI) Consensus Statement

“…[32][33][34] However, treatment with a DPP-4 inhibitor 1 or 2 days before cardiac and noncardiac surgery showed no benefit in preventing postoperative hyperglycemia compared to placebo in patients without diabetes. 35,36 Although these drugs have a relatively safe profile, in older patients with known or suspected heart failure, the use of DPP-4 inhibitors has been associated with worsening of heart failure. 37 Given the limited data showing significant benefit from DPP-4 inhibitors in preventing postoperative hyperglycemia, recommending their continued use on the day of surgery is not warranted for most patients.…”