Effect of continuous exenatide infusion on cardiac function and peri‐operative glucose control in patients undergoing cardiac surgery: A single‐blind, randomized controlled trial

• Published in: Diabetes, obesity & metabolism Vol. 19; no. 12; pp. 1818 - 1822
• Main Authors: Lipš, Michal, Mráz, Miloš, Kloučková, Jana, Kopecký, Petr, Dobiáš, Miloš, Křížová, Jarmila, Lindner, Jaroslav, Diamant, Michaela, Haluzík, Martin
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.12.2017; Wiley Subscription Services, Inc
• Subjects: Aged; Blood glucose; Cardiac arrhythmia; cardiac surgery; Cardiotonic Agents - administration & dosage; Cardiotonic Agents - adverse effects; Cardiotonic Agents - therapeutic use; Clinical trials; Coronary artery; Coronary Artery Bypass - adverse effects; Czech Republic - epidemiology; Drug Therapy, Combination - adverse effects; Evidence-based medicine; exenatide; Female; GLP-1 receptor agonists; Glucagon; Glucagon-Like Peptide-1 Receptor - agonists; Glucagon-Like Peptide-1 Receptor - metabolism; Glucose; Heart; Heart - drug effects; Heart - physiopathology; heart function; Heart surgery; Hospitals, University; Humans; Hyperglycemia - blood; Hyperglycemia - epidemiology; Hyperglycemia - prevention & control; Hypoglycemia; Hypoglycemia - blood; Hypoglycemia - chemically induced; Hypoglycemia - epidemiology; Hypoglycemia - prevention & control; Hypoglycemic Agents - administration & dosage; Hypoglycemic Agents - adverse effects; Hypoglycemic Agents - therapeutic use; Incidence; Incretins - administration & dosage; Incretins - adverse effects; Incretins - therapeutic use; Infusions, Intravenous; Insulin; Insulin - administration & dosage; Insulin - adverse effects; Insulin - therapeutic use; Intraoperative Complications - blood; Intraoperative Complications - chemically induced; Intraoperative Complications - epidemiology; Intraoperative Complications - prevention & control; Intravenous administration; Male; Peptides - administration & dosage; Peptides - adverse effects; Peptides - therapeutic use; Perioperative Care - adverse effects; peri‐operative glucose control; Postoperative Complications - blood; Postoperative Complications - chemically induced; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Proof of Concept Study; Risk; Single-Blind Method; Venoms - administration & dosage; Venoms - adverse effects; Venoms - therapeutic use; Ventricle; Ventricular Dysfunction, Left - blood; Ventricular Dysfunction, Left - surgery; cardiac surgery; heart function; peri-operative glucose control; exenatide
• ISSN: 1462-8902; 1463-1326; 1463-1326
• DOI: 10.1111/dom.13029

We performed a randomized controlled trial with the glucagon‐like peptide‐1 (GLP‐1) receptor agonist exenatide as add‐on to standard peri‐operative insulin therapy in patients undergoing elective cardiac surgery. The aims of the study were to intensify peri‐operative glucose control while minimizing the risk of hypoglycaemia and to evaluate the suggested cardioprotective effects of GLP‐1‐based treatments. A total of 38 patients with decreased left ventricular systolic function (ejection fraction ≤50%) scheduled for elective coronary artery bypass grafting (CABG) were randomized to receive either exenatide or placebo in a continuous 72‐hour intravenous (i.v.) infusion on top of standard peri‐operative insulin therapy. While no significant difference in postoperative echocardiographic variables was found between the groups, participants receiving exenatide showed improved peri‐operative glucose control as compared with the placebo group (average glycaemia 6.4 ± 0.5 vs 7.3 ± 0.8 mmol/L; P < .001; percentage of time in target range of 4.5–6.5 mmol/L 54.8% ± 14.5% vs 38.6% ± 14.4%; P = .001; percentage of time above target range 39.7% ± 13.9% vs 52.8% ± 15.2%; P = .009) without an increased risk of hypoglycaemia (glycaemia <3.3 mmol/L: 0.10 ± 0.32 vs 0.21 ± 0.42 episodes per participant; P = .586). Continuous administration of i.v. exenatide in patients undergoing elective CABG could provide a safe option for intensifying the peri‐operative glucose management of such patients.