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Perioperative sitagliptin ineffective for stress hyperglycemia in patients without diabetes

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September 28, 2018

Among patients without diabetes who undergo general surgery, perioperative use of the DPP-IV inhibitor sitagliptin fails to prevent stress hyperglycemia and its complications, according to findings from a pilot study.

“The current standard of care from national medical associations is to treat stress hyperglycemia with intravenous insulin in the ICU or with subcutaneous insulin regimens in non-ICU settings,” Maya Fayfman, MD, assistant professor of medicine at Emory University School of Medicine, and colleagues wrote in the study background. “Although effective, intensive insulin therapy is costly and requires significant nursing resources and is associated with [an approximately] 20% to 30% risk of hypoglycemia. DPP-IV inhibitors are a class of oral glucose-lowering agents that reduce breakdown of endogenous GLP-1 stimulating insulin secretion in a glucose-dependent manner.”

Researchers analyzed data from 80 surgical patients without diabetes and no history of preoperative hyperglycemia recruited from Emory University Hospital and Grady Memorial Hospital in Atlanta between April 2016 and March 2017.

Researchers randomly assigned patients undergoing general surgery to once-daily sitagliptin (Januvia, Merck; n = 44) or placebo (n = 36), beginning 1 day preoperatively and continuing throughout the hospital stay. Study investigators, coordinators and clinicians were masked to group assignments.

Primary outcome was incidence of stress hyperglycemia, defined as a blood glucose level greater than 140 mg/dL and greater than 180 mg/dL after surgery. Secondary outcomes included hospital length of stay, ICU transfers, hypoglycemia and hospital complications.

The researchers found that 55% of the participants had blood glucose level greater than 140 mg/dL after surgery.

There were no between-group differences in rates of stress hyperglycemia in the placebo vs. the sitagliptin group (56% vs. 55%, respectively). Researchers found that patients assigned placebo were more likely to experience a blood glucose level greater than 180 mg/dL vs. the sitagliptin group (19% vs. 11%), but the difference was not statistically significant. Similar postoperative blood glucose values were achieved with placebo and sitagliptin (mean, 148.9 mg/dL vs. 146.9 mg/dL, respectively).

In comparing placebo vs. sitagliptin, there were no between-group differences for hospital length of stay (4 days vs. 3 days, respectively), ICU transfer (3% vs. 5%, respectively), hypoglycemia (6% vs. 11%, respectively) or complications (14% vs. 18%, respectively).

“The results of this pilot study suggest that the use of sitagliptin, given 1 day before surgery and continued during the hospital stay, although safe, did not reduce the development of stress hyperglycemia in patients without a history of diabetes undergoing general surgery,” the researchers wrote. – by Jennifer Byrne

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Disclosures: Fayfman reports she has received an Emory Medical Care Foundation internal grant. Please see the study for all other authors’ relevant financial disclosures.

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