DPP-4i plus insulin on par with other regimens for glucose control after cardiac surgery

Glucose control among postoperative cardiac surgery patients with prediabetes or diabetes receiving dipeptidyl peptidase-4 inhibitors (DPP-4i) plus basal insulin is similar to those on other regimens, a study has shown. In addition, use of DPP-4i does not result in hypoglycaemia.

“DPP-4i plus basal insulin is noninferior to insulin monotherapy for glycaemic control in medical–surgical patients, but data in postoperative cardiac surgery patients are sparse,” the authors said.

To address this, patients with prediabetes or diabetes who underwent cardiac surgery at our hospital between May 2016 and June 2017 were retrospectively identified. Those included were grouped into the following cohorts: DPP-4i plus insulin and other antihyperglycaemic regimens.

The authors obtained blood glucose levels on postoperative days 2 to 7. They then compared uncontrolled glucose (≥2 measurements <80 or >180 mg/dL in 1 day), hyperglycaemia (>2 measurements ≥180 mg/dL in 1 day), and hypoglycaemia (any measurement <70 mg/dL) between cohorts using logistic regression adjusted for home antihyperglycaemics.

Of the 135 cardiac surgery patients included, 65 received DPP-4i plus insulin; 82 patients also received antihyperglycaemics at home. Of the participants, 61 (45.2 percent) had uncontrolled glucose, while 50 (37.0 percent) and 24 (17.8 percent) had hyperglycaemia and hypoglycaemia, respectively.

No difference was seen in the adjusted odds of uncontrolled glucose (odds ratio [OR], 1.43, 95 percent confidence interval [CI], 0.65–3.11), hyperglycaemia (OR, 1.20, 95 percent CI, 0.52–2.78), or hypoglycaemia (OR, 0.69, 95 percent CI, 0.27–1.75) between patients receiving DPP-4i plus insulin and those receiving other antihyperglycaemic regimens.