Saint Luke's Mid America Heart Institute University of Missouri-Kansas City, Kansas City, MO 64111, USA.
Endocr Pract. 2013 Jan-Feb;19(1):81-90. doi: 10.4158/EP12196.OR.
To evaluate the feasibility, effectiveness, and safety of intravenous exenatide to control hyperglycemia in the cardiac intensive care unit (CICU).
A prospective, single-center, open-label, nonrandomized pilot study. Forty patients admitted to the CICU with glucose levels of 140 to 400 mg/dL received intravenous exenatide as a bolus followed by a fixed dose infusion for up to 48 hours. Exenatide effectiveness was benchmarked to two historical insulin infusion cohorts, one (INT) with a target glucose of 90 to 119 mg/dL (n = 84) and the other (MOD) with a target of 100 to 140 mg/dL (n = 71).
Median admission glucose values were 185.5 mg/dL (161.0, 215.5), 259.0 mg/dL (206.0, 343.0), and 189.5 mg/dL (163.5, 245.0) in the exenatide, MOD, and INT groups, respectively (P<.001). Steady state glucose values were similar between the exenatide (132.0 mg/dL [110.0, 157.0]) and the MOD groups (127.0 mg/dL [105.0, 161.0], P = .15), but lower in the INT group (105.0 mg/dL [92.0, 128.0], P<.001 for exenatide versus INT). Median (IQR) time to steady state was 2.0 hours (1.5, 5.0) in the exenatide group compared to 12.0 hours (7.0, 15.0) in the MOD group (P<.001) and 3.0 hours (1.0, 5.0) in the INT group (P = .80 for exenatide versus INT). Exenatide was discontinued in 3 patients after failure to achieve glycemic control. No episodes of severe hypoglycemia (<50 mg/dL) occurred in patients who received exenatide. Nausea was reported by 16 patients and vomiting by 2 patients.
Intravenous exenatide is effective in lowering glucose levels in CICU patients, but its use may be limited by nausea.
评估静脉给予 exenatide 控制心脏重症监护病房（CICU）高血糖的可行性、有效性和安全性。
一项前瞻性、单中心、开放标签、非随机的初步研究。40 名血糖水平在 140 至 400mg/dL 之间的 CICU 患者接受静脉给予 exenatide 推注，随后进行固定剂量输注，最长可达 48 小时。将 exenatide 的疗效与两个历史胰岛素输注队列进行比较，一个队列（INT）的目标血糖为 90 至 119mg/dL（n = 84），另一个队列（MOD）的目标血糖为 100 至 140mg/dL（n = 71）。
exenatide、MOD 和 INT 组患者的中位入院血糖值分别为 185.5mg/dL（161.0，215.5）、259.0mg/dL（206.0，343.0）和 189.5mg/dL（163.5，245.0）（P<.001）。exenatide 组（132.0mg/dL [110.0，157.0]）和 MOD 组（127.0mg/dL [105.0，161.0]）的稳态血糖值相似（P =.15），但 INT 组的血糖值较低（105.0mg/dL [92.0，128.0]，P<.001）。exenatide 组中位（IQR）达到稳态的时间为 2.0 小时（1.5，5.0），而 MOD 组为 12.0 小时（7.0，15.0）（P<.001），INT 组为 3.0 小时（1.0，5.0）（P =.80）。由于未能达到血糖控制，有 3 名患者在使用 exenatide 后停止治疗。接受 exenatide 治疗的患者中未发生严重低血糖（<50mg/dL）。16 名患者出现恶心，2 名患者出现呕吐。
静脉给予 exenatide 可有效降低 CICU 患者的血糖水平，但可能因恶心而受到限制。
