Sitagliptin for the Prevention and Treatment of Perioperative Hyperglycaemia in Patients with Type 2 Diabetes Undergoing Cardiac Surgery: A Randomised Controlled Trial.

Background Hyperglycaemia is associated with increased incidence of perioperative complications. We assessed whether treatment with sitagliptin, starting before surgery and continued during the hospital stay, can prevent and reduce the severity of perioperative hyperglycaemia in patients with type 2 diabetes undergoing coronary artery bypass graft (CABG) surgery. Martials and methods We conducted a double-blinded, placebo-control trial in adults with type 2 diabetes randomly assigned to receive sitagliptin or matching placebo starting one day prior to surgery and continued during the hospital stay. The primary outcome was difference in the proportion of patients with postoperative hyperglycaemia (blood glucose [BG] >10mmol/L [>180mg/dL]) in the intensive care unit (ICU). Secondary endpoints included differences in mean daily BG in the ICU and after transition to regular wards, hypoglycaemia, hospital complications, length of stay, and need of insulin therapy. Results We included 182 participants randomised to receive sitagliptin or placebo (91 per group, age 64±9 years, HbA1C: 7∙6±1∙5%, and diabetes duration: 10±9 years). There were no differences in number of patients with postoperative BG >10 mmol/L, mean daily BG in the ICU or after transition to regular floors, hypoglycaemia, hospital complications or length of stay. There were no differences on insulin requirements in the ICU; however, sitagliptin therapy was associated with lower mean daily insulin requirements (21∙1±18∙4 vs 32∙5±26∙3 units, p=0∙007) after transition to regular floor compared to placebo. Conclusion The administration of sitagliptin prior to surgery and during the hospital stay, did not prevent perioperative hyperglycaemia or complications after CABG. Sitagliptin therapy was associated with lower mean daily insulin requirements after transition to regular floors. This article is protected by copyright. All rights reserved.