Peri-operative management of patients with type-2 diabetes mellitus undergoing non-cardiac surgery using liraglutide, glucose-insulin-potassium infusion or intravenous insulin bolus regimens: a randomised controlled trial
| Autor: | J. H. DeVries, Jeroen Hermanides, S. C. J. van Steen, M. B. Godfried, Jorinde A. W. Polderman, Benedikt Preckel, B. Thiel, P. L. Houweling, M. W. Hollmann |
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| Přispěvatelé: | Anesthesiology, Graduate School, AII - Inflammatory diseases, ACS - Amsterdam Cardiovascular Sciences, AII - Amsterdam institute for Infection and Immunity, AGEM - Amsterdam Gastroenterology Endocrinology Metabolism, Endocrinology, APH - Quality of Care, ACS - Diabetes & metabolism, ACS - Heart failure & arrhythmias, ACS - Microcirculation |
| Rok vydání: | 2017 |
| Předmět: |
Blood Glucose
Male Nausea medicine.medical_treatment 030209 endocrinology & metabolism Perioperative Care law.invention 03 medical and health sciences 0302 clinical medicine Bolus (medicine) Randomized controlled trial law Diabetes mellitus medicine Humans Hypoglycemic Agents Insulin 030212 general & internal medicine Aged business.industry Liraglutide Type 2 Diabetes Mellitus Middle Aged medicine.disease Glucose Anesthesiology and Pain Medicine Diabetes Mellitus Type 2 Anesthesia Potassium Female Premedication medicine.symptom business medicine.drug |
| Zdroj: | Anaesthesia, 73(3), 332-339. Wiley-Blackwell |
| ISSN: | 0003-2409 |
| Popis: | In this open-label multicentre randomised controlled trial, we investigated three peri-operative treatment strategies to lower glucose and reduce the need for rescue insulin in patients aged 18-75 years with type-2 diabetes mellitus undergoing non-cardiac surgery. Patients were randomly allocated using a web-based randomisation program to premedication with liraglutide (liraglutide group), glucose-insulin-potassium infusion (insulin infusion group) or insulin bolus regimen (insulin bolus group), targeting a glucose < 8.0 mmol.l-1 . The primary outcome was the between group difference in median glucose levels 1 h after surgery. We analysed 150 patients (liraglutide group n = 44, insulin infusion group n = 53, insulin bolus group n = 53) according to the intention-to-treat principle. Median (IQR [range]) plasma glucose 1 h postoperatively was lower in the liraglutide group compared with the insulin infusion and insulin bolus groups (6.6 (5.6-7.7 [4.2-13.5]) mmol.l-1 vs. 7.5 (6.4-8.3 [3.9-16.6]) mmol.l-1 (p = 0.026) and 7.6 (6.4-8.9 [4.7-13.2]) mmol.l-1 ) p = 0.006, respectively). The incidence of hypoglycaemia and postoperative complications did not differ between the groups. Six patients had pre-operative nausea in the liraglutide group, of which two had severe nausea, compared with no patients in the insulin infusion and insulin bolus groups (p = 0.007). The pre-operative administration of liraglutide stabilised peri-operative plasma glucose levels and reduced peri-operative insulin requirements, at the expense of increased pre-operative nausea rates. |
| Databáze: | OpenAIRE |
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