Medicine, Emory University School of Medicine, Atlanta, Georgia, USA.
Biostatitics, Rollins School of Public Health, Atlanta, Georgia, USA.
BMJ Open Diabetes Res Care. 2019 Sep 3;7(1):e000703. doi: 10.1136/bmjdrc-2019-000703. eCollection 2019.
To determine if treatment with sitagliptin, a dipeptidyl peptidase-4 inhibitor, can prevent stress hyperglycemia in patients without diabetes undergoing coronary artery bypass graft (CABG) surgery.
We conducted a pilot, double-blinded, placebo-controlled randomized trial in adults (18-80 years) without history of diabetes. Participants received sitagliptin or placebo once daily, starting the day prior to surgery and continued for up to 10 days. Primary outcome was differences in the frequency of stress hyperglycemia (blood glucose (BG) >180 mg/dL) after surgery among groups.
We randomized 32 participants to receive sitagliptin and 28 to placebo (mean age 64±10 years and HbA1c: 5.6%±0.5%). Treatment with sitagliptin resulted in lower BG levels prior to surgery (101±mg/dL vs 107±13 mg/dL, p=0.01); however, there were no differences in the mean BG concentration, proportion of patients who developed stress hyperglycemia (21% vs 22%, p>0.99), length of hospital stay, rate of perioperative complications and need for insulin therapy in the intensive care unit or during the hospital stay.
The use of sitagliptin during the perioperative period did not prevent the development of stress hyperglycemia or need for insulin therapy in patients without diabetes undergoing CABG surgery.
确定二肽基肽酶-4 抑制剂西他列汀是否可以预防无糖尿病病史的冠状动脉旁路移植术（CABG）患者的应激性高血糖。
我们进行了一项试点、双盲、安慰剂对照的随机临床试验，纳入了无糖尿病病史的成年人（18-80 岁）。参与者接受西他列汀或安慰剂，每日一次，术前一天开始，持续 10 天。主要结局是各组术后应激性高血糖（血糖（BG）>180mg/dL）的频率差异。
我们将 32 名参与者随机分配至西他列汀组，28 名参与者分配至安慰剂组（平均年龄 64±10 岁，HbA1c：5.6%±0.5%）。西他列汀治疗可降低术前的 BG 水平（101±mg/dL 与 107±13mg/dL，p=0.01）；然而，两组间的平均 BG 浓度、发生应激性高血糖的患者比例（21%比 22%，p>0.99）、住院时间、围手术期并发症发生率以及 ICU 或住院期间胰岛素治疗的需求均无差异。
在 CABG 手术期间使用西他列汀并不能预防无糖尿病病史患者发生应激性高血糖或胰岛素治疗的需求。
