Effect of continuous exenatide infusion on cardiac function and peri‐operative glucose control in patients undergoing cardiac surgery: A single‐blind, randomized controlled trial

To intensify perioperative glucose control while minimizing the risk of hypoglycemia and to evaluate the suggested cardioprotective effects of GLP-1-based treatments we performed a randomized controlled trial with the GLP-1 receptor agonist exenatide as add-on to standard perioperative insulin therapy in subjects undergoing elective cardiac surgery. 38 subjects with decreased left ventricular systolic function (ejection fraction ≤50%) scheduled for elective CABG (coronary artery by-pass grafting) were randomized to receive either exenatide or placebo in a continuous 72-hour i.v. infusion on top of standard perioperative insulin therapy. While no significant difference in postoperative echocardiographic parameters was found between the groups, subjects receiving exenatide showed improved perioperative glucose control as compared with the placebo group (average glycemia 6.4 ± 0.5 vs. 7.3 ± 0.8 mmol/l, p < 0.001; time in target range of 4.5-6.5 mmol/l 54.8 ± 14.5 vs. 38.6 ± 14.4%, p = 0.001; time above target range 39.7 ± 13.9 vs. 52.8 ± 15.2%, p = 0.009) without increased risk of hypoglycemia (glycemia < 3.3 mmol/l: 0.10 ± 0.32 vs. 0.21 ± 0.42 episodes per subject, p = 0.586). Continuous administration of i.v. exenatide in subjects undergoing elective CABG could provide a safe option for intensifying perioperative glucose management in cardiac surgery patients.