Liraglutide shows benefit for hyperglycemia in cardiac surgery

  • Hulst AH & al.
  • Diabetes Obes Metab
  • 20 Nov 2019

  • International Clinical Digest
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Takeaway

  • In patients undergoing cardiac surgery, pre- and perioperative liraglutide (Victoza) use reduced insulin requirements and improved glycemic control without increasing hypoglycemia.

Why this matters

  • Most cardiac surgery patients, with or without diabetes, develop perioperative hyperglycemia.
  • The only current treatment option, intravenous insulin, is labor-intensive and carries hypoglycemia risk.

Study design

  • Trial randomly assigned 278 patients (84% with diabetes) to subcutaneous liraglutide or placebo, given the night before cardiac surgery (0.6 mg) and after anesthesia induction (1.2 mg).
  • Funding: Novo Nordisk.

Key results

  • Proportion needing any insulin administered was 43% with liraglutide vs 61% placebo (P=.003). 
  • Total intraoperative dose (P=.003) and number of administrations (P=.001) were also lower with liraglutide.  
  • Proportion of patients requiring insulin in first 24 postoperative hours did not differ (37% with drug vs 41% placebo; P=.54). 
  • Median total dose administered also did not differ (P=.63).
  • Mean intraoperative blood glucose was lower with liraglutide (6.3 vs 7.0 mmol/L; P<.0001>
  • No difference in hypoglycemia (

Limitations

  • Exclusions for heart failure and chronic kidney disease that were later deemed unnecessary by clinical trial results.
  • Liraglutide dose studied may have been insufficient.

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