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

Diabetes Obes Metab. 2017 Dec;19(12):1818-1822. doi: 10.1111/dom.13029. Epub 2017 Jul 31.

Abstract

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.

Trial registration: ClinicalTrials.gov NCT01373216.

Keywords: cardiac surgery; exenatide; heart function; peri-operative glucose control.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Aged
  • Cardiotonic Agents / administration & dosage*
  • Cardiotonic Agents / adverse effects
  • Cardiotonic Agents / therapeutic use
  • Coronary Artery Bypass / adverse effects*
  • Czech Republic / epidemiology
  • Drug Therapy, Combination / adverse effects
  • Exenatide
  • Female
  • Glucagon-Like Peptide-1 Receptor / agonists
  • Glucagon-Like Peptide-1 Receptor / metabolism
  • Heart / drug effects*
  • Heart / physiopathology
  • Hospitals, University
  • Humans
  • Hyperglycemia / blood
  • Hyperglycemia / epidemiology
  • Hyperglycemia / prevention & control*
  • 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 / administration & dosage
  • Insulin / adverse effects
  • Insulin / therapeutic use
  • Intraoperative Complications / blood
  • Intraoperative Complications / chemically induced
  • Intraoperative Complications / epidemiology
  • Intraoperative Complications / prevention & control*
  • Male
  • Peptides / administration & dosage*
  • Peptides / adverse effects
  • Peptides / therapeutic use
  • Perioperative Care / adverse effects
  • 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
  • Ventricular Dysfunction, Left / blood
  • Ventricular Dysfunction, Left / surgery

Substances

  • Cardiotonic Agents
  • Glucagon-Like Peptide-1 Receptor
  • Hypoglycemic Agents
  • Incretins
  • Insulin
  • Peptides
  • Venoms
  • Exenatide

Associated data

  • ClinicalTrials.gov/NCT01373216