Abstract 2540: Glucagon-Like Peptide-1 Improves Glycemic Control and Preserves Left Ventricular Function in Patients Undergoing Coronary Artery Bypass Grafting with Reduced Requirements for Insulin and Inotropes
Background: Increasing evidence suggests that tight glycemic control improves clinical outcomes following coronary artery bypass grafting (CABG). However, the risks of hypoglycemia with insulin result often in less aggressive glycemic control. Glucagon-Like Peptide-1 (GLP-1) is a naturally occurring peptide whose insulinotropic effects are predicated on the glucose concentration minimizing the risk of hypoglycemia. We sought to examine whether perioper-ative treatment with GLP-1 would affect better glycemic control and improve hemodynamic recovery following CABG surgery.
Methods: Sixteen patients with ischemic heart disease and preserved left ventricular (LV) function who were scheduled to undergo CABG surgery received standard therapy at the discretion of surgeon and were randomized to receive treatment with GLP-1 (1.5 pmol/kg/min) or placebo (Con) as a continuous infusion, begun 12 hours prior to CABG and continued for 48 hours postoperatively. Perioperative hemodynamics, left ventricular ejection fraction (LVEF), plasma glucose, and requirements for insulin drips and inotropic support were monitored.
Results: There was no difference in preoperative LVEF or cardiac output. However, GLP-1 treated patients had higher LVEF at 48 hours postoperative (p=0.038). Importantly, the control group required greater use of dobutamine (Con: 53 mg/patient; GLP-1: 0 mg/patient, p<0.05) and/or epinephrine (Con: 2.2 mg/patient; GLP-1: 0.09 mg/patient) and had higher heart rates during the 48 hours postoperatively to achieve the same cardiac output. GLP-1 resulted in better glycemic control (preop: 103±15 mg/dL; postop: 95±12 mg/dL) compared to control (preop: 147±41 mg/dL; postop: 144±41 mg/dL, p<0.05) with less insulin requirements (Con: 56 U/patient; GLP-1: 21 U/patient, p<0.05).
Conclusion: Periop-erative use of GLP-1 achieves better glycemic control and comparable hemodynamic recovery without the requirements for high dose insulin or inotropes.