Management of Hyperglycemia with the Administration of Intravenous Exenatide to Patients in the Cardiac Intensive Care Unit.
Endocr Pract. 2012 Nov 27;:1-29
Authors: Abuannadi M, Kosiborod M, Riggs L, House JA, Hamburg MS, Kennedy KF, Marso SP
Objective: To evaluate the feasibility, effectiveness, and safety of intravenous exenatide to control hyperglycemia in the cardiac intensive care unit (CICU).Methods: A prospective, single-center, open-label, non-randomized, pilot study. Forty patients admitted to the CICU with glucose levels of 140-400mg/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 90-119 mg/dl (n=84), and the other (MOD) with a target of 100-140 mg/dl (n=71).Results: 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< 0.001). 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=0.15], but lower in the INT group [105.0 mg/dl (92.0, 128.0), p <0.001 for exenatide vs. 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 MOD group (P <0.001), and 3.0 hours (1.0, 5.0) in the INT group (P=0.80 for exenatide vs. 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 and vomiting by 2 patients.Conclusion: Intravenous exenatide is effective in lowering glucose levels in CICU patients, but its use may be limited by nausea.
PMID: 23186969 [PubMed - as supplied by publisher]