Article Text
Abstract
Aims To 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.
Methods We 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.
Results We 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.
Conclusion The 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.
- CABG
- stress hyperglycemia
- DPP-4 inhibitors
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Footnotes
SC and KT contributed equally.
Presented at Partial data from this trial were presented at the American Diabetes Association meeting in June 2017.
Collaborators Katherine Carssow, N Renee Cook, Michele Fielding, Sonya Mathewson and Maria A Urrutia. (SITA-CABG Collaborators)
Contributors GU is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. GU wrote the initial research proposal. SC, KT, and GU wrote the manuscript. FJP, RJG, PV, SJ, MH, RAG, and VHT reviewed/edited the research proposal and manuscript and contributed to the discussion. LP conducted the statistical analysis.
Funding GU is partly supported by research grants from the NIH/NATS (UL1 TR002378) from the Clinical and Translational Science Award program, and from NIH and National Center for Research Resources (1P30DK111024-01). FJP and PV are supported by NIH grants 1K23GM128221-01A1 and 3K12HD085850-03S1 respectively. GU has also received unrestricted research support for inpatient studies (to Emory University) from Merck, Novo Nordisk, AstraZeneca, Boehringer Ingelheim, and Sanofi. FJP received research support and consulting fees from Merck. FJP has received consulting fees from Boehringer Ingelheim, Lilly, and AstraZeneca. PV has received consulting fees from Merck and Boehringer Ingelheim. RJG has received unrestricted research support for research studies (to Emory University) from Novo Nordisk and consulting fees from Abbott, Sanofi, and Novo Nordisk.
Disclaimer The supporters of the study were not involved in the study design, data collection, analysis or interpretation of the results, or preparation of the manuscript.
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval The study protocol and consent were approved by the Emory University Institutional Review Board.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement Data are available upon reasonable request.