Addition of low‐dose liraglutide to insulin therapy is useful for glycaemic control during the peri‐operative period: effect of glucagon‐like peptide‐1 receptor agonist therapy on glycaemic control in patients undergoing cardiac surgery (GLOLIA study)

Abstract

Aim To test the hypothesis that the addition of a glucagon‐like peptide‐1 receptor agonist that can decrease glucose levels without increasing the hypoglycaemia risk will achieve appropriate glycaemic control during the peri‐operative period. Methods We studied 70 people with Type 2 diabetes who underwent elective cardiac surgery. Participants were randomized to either an insulin‐alone or an insulin plus liraglutide 0.6 mg/day group. We evaluated average M values, which indicated the proximity index of the target glucose level from day 1 to day 10. Results The average M value in the liraglutide plus insulin group was significantly lower than that in the insulin‐alone group (liraglutide plus insulin 5.8 vs insulin‐alone 12.3; P < 0.001). The frequency of insulin dose modification in the liraglutide plus insulin group was significantly lower than that in the insulin‐alone group (odds ratio 0.19, 95% CI 0.08–0.49; P < 0.001). The frequency of hypoglycaemia in the liraglutide plus insulin group tended to be lower than that in the insulin‐alone group (odds ratio 0.57, 95% CI 0.15–2.23; P = 0.21). Conclusions The results of this study showed that the addition of low‐dose liraglutide to insulin achieved lower M values than insulin alone, suggesting that the addition of low‐dose liraglutide may achieve better glycaemic control during the peri‐operative period. (Clinical trials registry no.: UMIN 000008003)

Management of diabetes and hyperglycaemia in the hospital

“…[94][95][96] Findings from randomised controlled trials suggest preoperative treatment with liraglutide can improve glycaemic control in the perioperative period in patients with and without diabetes (table 2). 88,91,97 In a study of non-ICU patients with type 2 diabetes, treatment with exenatide plus basal insulin resulted in a higher proportion of glucose readings within the target range of 3•9-10•0 mmol/L (78%) compared with exenatide alone (62%) or basalbolus insulin (63%). 68 As expected, trials with GLP-1 receptor agonists have shown increased frequencies of gastrointestinal side-effects.…”

“…68 As expected, trials with GLP-1 receptor agonists have shown increased frequencies of gastrointestinal side-effects. 68,88,91,97 More research is needed with these drugs to determine if the potential for improved glycaemic control with a reduction of hypoglycaemic events counterbalances the increase in gastrointestinal side-effects in the hospital setting.…”

Position statement: surgery and diabetes mellitus (Update 2023)

“…Insulinbedarf und verbesserte glykämische Kontrolle [ 111 ]. Auch die GLOLIA Studie, in der Liraglutid bei Kardiochirurgie als Kombinationstherapie zu Insulin bei Menschen mit DMT2 eingesetzt wurde, ergab perioperativ Hinweise für eine verbesserte Glykämie [ 112 ]. In einem Kollektiv von Menschen mit DMT2 und nicht kardiochirurgischen Eingriffen konnte eine randomisiert-kontrollierte Studie mit Liraglutid (versus Glukose-Insulin-Kalium-Infusion oder i.v.…”

Negative pressure wound therapy (NPWT) is superior to conventional moist dressings in wound bed preparation for diabetic foot ulcers

“…Since the patients would receive STSG surgery recently, insulin pumps were applied for glycaemic control (therapeutic goal: fasting blood glucose (FBG) ≤8.8 mmol/l). 15 The strategies for improving blood perfusion included keeping warm, smoking cessation, and the combined use of vasodilator and antiplatelet aggregation drugs (aspirin, dipyridamole, prostaglandin, or clopidogrel). The offloading therapies were as follows: During hospitalization, all the patients were asked to elevate their affected leg with a cushion.…”