60-OR: Sitagliptin for the Prevention and Treatment of Perioperative Hyperglycemia in Diabetic Patients Undergoing Cardiac Surgery

Perioperative hyperglycemia (BG >180 mg/dl) is reported in more than 80% of patients with T2D after cardiac surgery and is associated with high morbidity and mortality. Continuous insulin infusion (CII), the recommended for treatment of perioperative hyperglycemia is labor intensive and is associated with hypoglycemia risk. Because, treatment with DPP-4is has been shown to improve glucose control without hypoglycemia in general surgery patients, we conducted a double-blinded randomized trial to test the hypothesis that sitagliptin could prevent and treat hyperglycemia after CABG. A total of 202 patients with T2D were randomized to sitagliptin (n=101) or placebo (n=101) once daily, starting the day prior to surgery and continued in the ICU and after transition to regular wards. We observed no differences in BG prior to or during surgery, ICU stay or after transition to floor between groups. There were no differences in the number of patients requiring insulin therapy in the ICU or in regular floors, frequency of hypoglycemia or in hospital complications. Sitagliptin was associated with lower SQ insulin requirements without increased risk of hyper- or hypoglycemia compared to placebo after transition to regular floor. Conclusion: Sitagliptin cannot be recommended for the prevention or treatment of perioperative hyperglycemia in patients with T2D undergoing cardiac surgery.