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 (<4.0 mmol/L; 3% with drug vs 2% without; P=.72), incidence of nausea/vomiting before or after surgery, length of stay, or mortality.
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.
References
References
