Adjunctive Sitagliptin Therapy in Postoperative Cardiac Surgery Patients: A Pilot Study

Abstract

Aim. We aimed to determine if sitagliptin added to standard postoperative standardized sliding-scale insulin regimens improved blood glucose. Methods. A prospective, randomized, double-blind, placebo-controlled pilot study was conducted in diabetic cardiac surgery patients. Patients received sitagliptin or placebo after surgery for 4 days. The primary endpoint was to estimate the effect of adjunctive sitagliptin versus placebo on overall mean blood glucose in the 4-day period after surgery. Results. Sixty-two patients participated. Repeated measures tests indicated no significant difference between the groups in the overall mean blood glucose level with a mean of 147.2 ± 4.8 mg/dL and 153.0 ± 4.6 mg/dL for the test and the control group, respectively (P = 0.388). Conclusions. Sitagliptin added to normal postoperative glucose management practices did not improve overall mean blood glucose control in diabetic patients in the postoperative setting.

Systematic review of incretin therapy during peri-operative and intensive care

“…Studies assessing the efficacy of the oral DPP-IV inhibitor sitagliptin for post-operative glycaemic control in patients with T2DM have reported varied results. In the study by Brackbill and colleagues the post-CABG addition of sitagliptin (100 mg once daily) to standard subcutaneous basal insulin and regular oral hypoglycaemic agents did not result in any difference in glycaemia or insulin administration [ 20 ]. Two related studies on the ward, one [ 33 ] a pilot preceding a larger trial [ 32 ], which included both medical and surgical patients (Table 1 ), assessed sitagliptin (100 mg once daily) as an adjunct to a basal insulin when compared with a standard basal bolus insulin regimen.…”

“…Eight studies were performed exclusively in patients with T2DM [ 18 , 20 , 23 , 29 , 31 – 33 , 35 ], five studies in patients without T2DM [ 21 , 22 , 26 , 28 , 30 ] and a further six studies in mixed cohorts of patients with and without T2DM (Table 1 ) [ 17 , 19 , 24 , 25 , 27 , 34 ]. None of the studies recruiting mixed populations reported subgroup analyses according to diabetic status.…”

Sitagliptin for prevention of stress hyperglycemia in patients without diabetes undergoing general surgery: A pilot randomized study

“…14,30 Similar to our results, a recent pilot study by Brackbill et al , showed sitagliptin therapy in patients with DM following cardiac surgery resulted in non significant differences in glycemic control compared to insulin therapy. 31…”

Effects of antidiabetic medications on cardiovascular outcomes

“…Kohl et al 16 evaluated the efficiency of intravenous GLP‐1 infusion compared with a placebo in mitigating intraoperative hyperglycemia in cardiac surgery, with the results showing that GLP‐1 intravenous administration is indicated in preventing perioperative hyperglycemia, with no significant risk of hypoglycemia. Brackbill et al 27 investigated whether the addition of Sitagliptin to the standard postoperative sliding‐scale insulin regimens improved blood glucose. Results showed no significant differences in blood glucose between groups; therefore, showing that Sitagliptin did not improve blood glucose control when used as an adjunct 27 …”

“…Brackbill et al 27 investigated whether the addition of Sitagliptin to the standard postoperative sliding‐scale insulin regimens improved blood glucose. Results showed no significant differences in blood glucose between groups; therefore, showing that Sitagliptin did not improve blood glucose control when used as an adjunct 27 …”