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J Pharm Pract. 2019 Aug 13:897190019867850. doi: 10.1177/0897190019867850. [Epub ahead of print]

Outcomes Associated With the Adjunctive Use of Dipeptidyl Peptidase-4 Inhibitors With Insulin Versus Other Antihyperglycemic Medications in Patients With Prediabetes or Diabetes After Cardiac Surgery.

Author information

1
1 South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA.
2
2 Department of Clinical Pharmacy and Outcomes Sciences, South Carolina College of Pharmacy, Medical University of South Carolina, Charleston, SC, USA. Clark is now with the Department of Pharmacy at Tampa General Hospital, Tampa, FL, USA. Griffin is now with the Department of Pharmacy at the University of Virginia Health System, Charlottesville, VA, USA. Jones is now with the Department of Pharmacy at the University of North Carolina Health Care, Chapel Hill, NC, USA.

Abstract

BACKGROUND:

Dipeptidyl peptidase-4 inhibitors (DPP-4i) plus basal insulin is noninferior to insulin monotherapy for glycemic control in medical-surgical patients, but data in postoperative cardiac surgery patients are sparse.

OBJECTIVE:

To compare glucose control in postoperative cardiac surgery patients with prediabetes or diabetes receiving a DPP-4i plus insulin versus other antihyperglycemic regimens.

METHODS:

We retrospectively identified patients with prediabetes or diabetes who underwent cardiac surgery at our hospital between May 2016 and June 2017. Included patients were stratified into cohorts: (1) DPP-4i plus insulin and (2) other antihyperglycemic regimens. Blood glucose levels were collected on postoperative days 2 to 7. Uncontrolled glucose (≥2 measurements <80 or >180 mg/dL in 1 day), hyperglycemia (>2 measurements ≥180 mg/dL in 1 day), and hypoglycemia (any measurement <70 mg/dL) were compared between cohorts using logistic regression adjusted for home antihyperglycemics.

RESULTS:

We included 135 cardiac surgery patients, of which 65 received DPP-4i plus insulin. Eighty-two patients received antihyperglycemics at home. Uncontrolled glucose occurred in 61 (45.2%) patients; while hyperglycemia and hypoglycemia occurred in 50 (37.0%) and 24 (17.8%) patients, respectively. There was no difference in the adjusted odds of uncontrolled glucose (odds ratio [OR] = 1.43; 95% confidence interval [CI] = 0.65-3.11), hyperglycemia (OR = 1.20; 95% CI = 0.52-2.78), or hypoglycemia (OR = 0.69; 95% CI = 0.27-1.75) for those receiving DPP-4i plus insulin versus other regimens.

CONCLUSION:

Glucose control was no different among postoperative cardiac surgery patients receiving a DPP-4i plus insulin versus other regimens. DPP-4i use was not associated with hypoglycemia.

KEYWORDS:

blood glucose; cardiac surgical procedures; diabetes mellitus; dipeptidyl-peptidase IV inhibitors; insulin

PMID:
31409190
DOI:
10.1177/0897190019867850

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