Background
Methods
Eligibility criteria
Search strategy
Study selection
Risk-of-bias assessment
Data extraction
Statistical analysis
Results
Study characteristics
Author, year | Participants, setting, n | DM, n (%) | Intervention duration | Intervention, dose, n | Comparator, n | Standard glycaemic therapy | Outcome parameters |
---|---|---|---|---|---|---|---|
Besch, 2017 [19] | CABG, OR + ICU n = 104 | 22 (21%) | 48 h | Exenatide IV 25 ng/min n = 53 | Standard glycaemic therapy n = 51 | Continuous insulin IV + bolus regimen | Glycaemia
Insulin administration, complications, LoS
|
Brackbill, 2012 [20] | CABG, ward, n = 62 | 62 (100%) | 4 d | Sitagliptin PO 100 mg q.d. n = 30 | Placebo n = 32 | Basal bolus insulin SC regimen | Glycaemia
LoS
|
Deane, 2009 [21] | Mechanically ventilated, ICU n = 7 | 0 (0%) | 240 min | GLP-1 IV 1.2 pmol/kg/min n = 7 | Placebo n = 7 | None | Glycaemia
Insulinaemia, Glucagon, GLP-1
|
Deane, 2010 [22] | Mechanically ventilated, ICU n = 25 | 0 (0%) | 360 min | GLP-1 IV 1.2 pmol/kg/min n = 25 | Placebo n = 25 | None | Glycaemia
Gastric emptying, glucose absorption, Insulinaemia, Glucagon
|
Deane, 2011 [23] | Mechanically ventilated, ICU n = 11 | 11 (100%) | 240 min | GLP-1 IV 1.2 pmol/kg/min n = 11 | Placebo n = 11 | None | Glycaemia
Insulinaemia, C-peptide, glucagon, FFA
|
Galiatsatos, 2014 [24] | Surgical/burn, ICU n = 18 | 9 (50%) | 72 h | GLP-1 IV 1.5 pmol/kg/min n = 9 | Saline n = 9 | Intensive insulin treatment protocol | Glycaemia
Insulin administration, glucagon, C-peptide, CV medication
|
Garg, 2017 [35] | In hospital, ward (74% surgical) n = 66 | 66 (100%) | 5 d | Saxagliptin PO 5 mg q.d. n = 33 | Basal bolus insulin SC regimen n = 33 | Corrective insulin bolus regimen | Glycaemia
Insulin administration, Treatment failure, LoS
|
Holmberg, 2014 [25] | CABG, OR n = 62 | 12 (19%) | 390 min | Exenatide IV 43 ng/min n = 21 | RIPC n = 20 / Placebo n = 21 | Unknown | Cardiac enzymes
Complications, LoS
|
Kar, 2015 [26] | Mechanically ventilated, ICU n = 20 | 0 (0%) | 300 min | GIP IV 4 pmol/kg/min n = 20 | Placebo n = 20 | None | Glycaemia
Gastric emptying, glucose absorption, insulinaemia
|
Kohl, 2014 [27] | CABG, OR n = 77 | 11 (14%) | 72 h | GLP-1 IV 1.5 pmol/kg/min n = 37 | Placebo n = 40 | Continuous insulin IV + bolus regimen | Glycaemia
Insulinaemia, glucagon, GLP-1, cortisol, FFA.
|
Lee, 2013 [28] | Mechanically ventilated, ICU n = 20 | 0 (0%) | 300 min | GIP IV 4 pmol/kg/min n = 20 | Standard glycaemic therapy n = 20 | GLP-1 IV 1.2 pmol/kg/min (300 min) | Glycaemia
Insulinaemia, glucagon, GLP-1, GIP,
|
Lipš, 2017 [17] | CABG, OR n = 38 | 26 (68%) | 72 h | Exenatide IV 20 ng/min n = 19 | Placebo n = 19 | Intensive insulin treatment protocol | Glycaemia
Echocardiography, CV medications, complications
|
Meier, 2004 [29] | Major surgery, ward n = 8 | 100 (100%) | 8 h | GLP-1 IV 1.2 pmol/kg/min n = 8 | Placebo n = 8 | None | Glycaemia
Insulinaemia, C-peptide, glucagon, GLP-1
|
Miller, 2017 [30] | Mechanically ventilated, ICU n = 12 | 0 (0%) | 270 min | GLP-1 IV 1.2 pmol/kg/min n = 12 | Placebo n = 12 | None | Glycaemia
Glucose absorption
|
Müssig, 2008 [31] | CABG, ICU n = 20 | 100 (100%) | 12 h | GLP-1 IV 3.6 pmol/kg/min n = 10 | Continuous insulin IV n = 10 | Corrective insulin bolus regimen | Glycaemia
Insulin administration, haemodynamics
|
Pasquel, 2017 [32] | In hospital, ward (16% surgical) n = 277 | 100 (100%) | 10 d | Sitagliptin PO 100 mg q.d. n = 138 | Bolus insulin regimen n = 139 | Basal (glargine) insulin regimen | Glycaemia
Insulin administration, complications, treatment failure
|
Polderman, 2018 [18] | Surgical, OR n = 150 | 100 (100%) | 2 d | Liraglutide SC 0.6 mg + 1.2 mg n = 44 | GIK infusion n = 53/Bolus insulin algorithm n = 53 | Bolus insulin treatment algorithm | Glycaemia
Insulin administration,
Potassium, nausea, complications
|
Sokos, 2007 [34] | CABG, OR n = 20 | 5 (25%) | 60 h | GLP-1 IV 1.5 pmol/kg/min n = 10 | Standard insulin therapy n = 10 | Standard insulin therapy | Glycaemia
LVEF, haemodynamics
|
Umpierrez, 2014 [33] | In hospital, ward (45% surgical) n = 90 | 100 (100%) | 10 d | Sitagliptin PO 100 mg q.d. n = 27 / Sitagliptin + basal insulin n = 29 | Basal bolus insulin regimen n = 26 | Correction bolus insulin regimen | Glycaemia
Insulin administration, complications, treatment failure
|
Risk of bias
Efficacy of intervention
Author, year | Main outcome | Result |
---|---|---|
Meier, 2004 [29] | GLP-1 IV lowered mean glucose levels |
+
|
Sokos, 2007 [34] | GLP-1 IV reduced peri-operative glucose levels |
+
|
Müssig, 2008 [31] | GLP-1 IV reduced insulin administration with comparable glycaemic control | + |
Deane, 2009 [21] | GLP-1 IV lowered mean post-prandial glucose levels | + |
Deane, 2010 [22] | GLP-1 IV lowered mean post-prandial glucose levels | + |
Deane, 2011 [23] | GLP-1 IV lowered mean post-prandial glucose levels | + |
Galiatsatos, 2014 [24] | GLP-1 IV did not lower mean glucose levels | – |
Kohl, 2014 [27] | GLP-1 IV lowered mean glucose levels |
+
|
Miller, 2017 [30] | GLP-1 IV reduced intestinal glucose absorption |
+
|
Kar, 2015 [26] | GIP IV did not lower mean glucose levels |
–
|
Lee, 2013 [28] | GIP IV did not lower mean glucose levels |
–
|
Polderman, 2018 [18] | Liraglutide SC reduced post-operative glucose levels |
+
|
Holmberg, 2014 [25] | Exenatide IV did not lower post-operative cardiac enzymes | – |
Besch, 2017 [19] | Exenatide IV did not increase number of patient that spend > 50% in target range |
–
|
Lipš, 2017 [17] | Exenatide IV did not improve left ventricular ejection fraction |
–
|
Garg, 2017 [35] | Saxagliptin PO resulted in similar glucose levels compared with basal bolus insulin |
+
|
Pasquel, 2017 [32] | Sitagliptin PO as adjunct to basal insulin resulted in similar glucose levels compared with bolus insulin |
+
|
Umpierrez, 2014 [33] | Sitagliptin PO resulted in similar glucose levels compared with basal bolus insulin | – |
Brackbill, 2012 [20] | Sitagliptin PO did not lower the mean postoperative glucose levels |
–
|
Intra-operative glucose lowering
Post-operative glucose lowering
Intensive care unit
Hypoglycaemia
Author, year | Threshold to define hypoglycaemia | Incretin | Comparator | Weight | Odds ratio M-H, random, 95% CI | P value | Odds ratio M-H, random, 95% CI | ||
---|---|---|---|---|---|---|---|---|---|
n
| group |
n
| group | ||||||
Besch, 2017 [19] | 3.3 mmol L− 1 | 2 | 53 | 1 | 51 | 8.1% | 1.96 [0.17, 22.32] | 0.58 | |
Brackbill, 2012 [20] | 3.3 mmol L− 1 | 5 | 30 | 2 | 32 | 12.9% | 3.00 [0.54, 16.81] | 0.06 | |
Deane, 2010 [22] | 3.0 mmol L− 1 | 0 | 25 | 0 | 25 | Not estimable | 1 | ||
Galiatsatos, 2014 [24] | 2.8 mmol L− 1 | 1 | 9 | 3 | 9 | 7.8% | 0.25 [0.02, 3.04] | 0.58 | |
Garg, 2017 [35] | 3.9 mmol L− 1 | 1 | 33 | 1 | 33 | 5.7% | 1.00 [0.06, 16.69] | 1 | |
Holmberg, 2014 [25] | 4.0 mmol L− 1 | 8 | 21 | 0 | 41 | 6.1% | 52.26 [2.83, 966.6] | 0.003 | |
Kar, 2015 [26] | Not stated | 0 | 24 | 0 | 24 | Not estimable | 1 | ||
Kohl, 2014 [27] | 3.8 mmol L− 1 | 0 | 37 | 0 | 40 | Not estimable | 1 | ||
Lipš, 2017 [17] | 3.3 mmol L− 1 | 2 | 19 | 4 | 19 | 11.9% | 0.44 [0.07, 2.76] | 0.12 | |
Meier, 2004 [29] | 4.0 mmol L−1 | 0 | 8 | 0 | 8 | Not estimable | 1 | ||
Müssig, 2008 [31] | Not stated | 0 | 10 | 0 | 10 | Not estimable | 1 | ||
Pasquel, 2017 [33] | 3.9 mmol L−1 | 13 | 138 | 17 | 139 | 24.7% | 0.75 [0.35, 1.60] | 0.45 | |
Polderman, 2018 [18] | 4.0 mmol L−1 | 1 | 44 | 5 | 106 | 9.5% | 0.47 [0.05, 4.14] | 0.26 | |
Sokos, 2007 [34] | 3.3 mmol L−1 | 1 | 10 | 2 | 10 | 7.4% | 0.44 [0.03, 5.88] | 0.39 | |
Umpierrez, 2014 [33] | 3.9 mmol L−1 | 3 | 56 | 2 | 26 | 11.8% | 0.68 [0.11, 4.33] | 0.86 | |
Total (95% CI) | 484 | 540 | 100% | 0.97 [0.47, 2.02] | 0.94 | ||||
Total events | 37 | 37 |