Liraglutide for perioperative management of hyperglycemia in cardiac surgery patients: a multicenter randomized superiority trial.

Most cardiac surgery patients, with or without diabetes, develop perioperative hyperglycemia, for which intravenous insulin is the only therapeutic option. This is labor-intensive and carries a risk of hypoglycemia. We hypothesized that preoperative administration of the glucagon-like peptide-1 receptor agonist liraglutide reduces the number of patients requiring insulin for glycemic control during cardiac surgery.In this randomised, blinded, placebo-controlled, parallel-group, balanced (1:1), multicentre randomised, superiority trial, adult patients undergoing cardiac surgery in four Dutch tertiary hospitals were randomised to receive 0·6 mg subcutaneous liraglutide on the evening before surgery and 1·2 mg after induction of anaesthesia or matching placebo. Blood glucose was measured hourly and controlled using an insulin-bolus-algorithm. The primary outcome was insulin administration for blood glucose above 8·0 mmol/L in the operating theatre. Research pharmacists used centralised, stratified, variable-block, randomisation software. Patients, care providers, and study personnel were blinded to treatment allocation.Between June 2017 and August 2018, 278 patients were randomised to liraglutide (139) or placebo (139). All patients receiving at least one study drug injection were included in the intention-to-treat analyses (129 in the liraglutide group, 132 in the placebo group). In the liraglutide group 55 (43%) patients required additional insulin compared to 80 (61%) patients in the placebo group, absolute difference: 18% (95% CI 5·9-30·0, p=0·003). Dose and number of insulin injections and mean blood glucose were all significantly lower in the liraglutide group. We observed no difference in the incidence of hypoglycaemia, nausea and vomiting, mortality, or postoperative complications.Preoperative liraglutide, compared to placebo, reduces insulin requirements while improving perioperative glycemic control during cardiac surgery. REGISTRATION: trialregister.nl Identifier: NTR6323 FUNDING: Novo Nordisk This article is protected by copyright. All rights reserved.