Sitagliptin for Prevention of Stress Hyperglycemia in Patients Without Diabetes Undergoing General Surgery: A Pilot Randomized Study

J Diabetes Complications. 2018 Dec;32(12):1091-1096. doi: 10.1016/j.jdiacomp.2018.08.014. Epub 2018 Sep 1.

Abstract

Aim: We investigated if a dipeptidyl peptidase-4 inhibitor, sitagliptin, can prevent perioperative stress hyperglycemia in patients without prior history of diabetes mellitus undergoing general surgery.

Methods: This double-blind pilot trial randomized general surgery patients to receive sitagliptin (n = 44) or placebo (n = 36) once daily, starting one day prior to surgery and continued during the hospital stay. The primary outcome was occurrence of stress hyperglycemia, defined by blood glucose (BG) >140 mg/dL and >180 mg/dL after surgery. Secondary outcomes included: length-of-stay, ICU transfers, hypoglycemia, and hospital complications.

Results: BG >140 mg/dL was present in 44 (55%) of subjects following surgery. There were no differences in hyperglycemia between placebo and sitagliptin (56% vs. 55%, p = 0.93). BG >180 mg/dL was observed in 19% and 11% of patients treated with placebo and sitagliptin, respectively, p = 0.36. Both treatment groups had resulted in similar postoperative BG (148.9 ± 29.4 mg/dL vs. 146.9 ± 35.2 mg/dL, p = 0.73). There were no differences in length-of-stay (4 vs. 3 days, p = 0.84), ICU transfer (3% vs. 5%, p = 1.00), hypoglycemia <70 mg/dL (6% vs. 11%, p = 0.45), and complications (14% vs. 18%, p = 0.76).

Conclusion: Preoperative treatment with sitagliptin did not prevent stress hyperglycemia or complications in individuals without diabetes undergoing surgery.

Keywords: DPP4-inhibitors; Hospital complications; Inpatient; Perioperative management; Stress hyperglycemia.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Blood Glucose / drug effects
  • Blood Glucose / metabolism
  • Dipeptidyl-Peptidase IV Inhibitors / therapeutic use
  • Double-Blind Method
  • Feasibility Studies
  • Female
  • Hospitalization
  • Humans
  • Hyperglycemia / etiology
  • Hyperglycemia / prevention & control*
  • Male
  • Middle Aged
  • Pilot Projects
  • Preoperative Care / methods*
  • Sitagliptin Phosphate / therapeutic use*
  • Stress, Psychological / blood
  • Stress, Psychological / complications
  • Stress, Psychological / drug therapy*
  • Surgical Procedures, Operative / adverse effects
  • Surgical Procedures, Operative / psychology*
  • Young Adult

Substances

  • Blood Glucose
  • Dipeptidyl-Peptidase IV Inhibitors
  • Sitagliptin Phosphate