Management of hyperglycemia with the administration of intravenous exenatide to patients in the cardiac intensive care unit

Mohammad Abuannadi, Mikhail Kosiborod, Lisa Riggs, John A. House, Mitchell S. Hamburg, Kevin F. Kennedy, Steven P. Marso

Research output: Contribution to journalArticle

24 Citations (Scopus)

Abstract

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, nonrandomized pilot study. Forty patients admitted to the CICU with glucose levels of 140 to 400 mg/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 to 119 mg/dL (n = 84) and the other (MOD) with a target of 100 to 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<.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 = .15), but lower in the INT group (105.0 mg/dL [92.0, 128.0], P<.001 for exenatide versus 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 the MOD group (P<.001) and 3.0 hours (1.0, 5.0) in the INT group (P = .80 for exenatide versus 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 patients 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.

Original languageEnglish (US)
Pages (from-to)81-90
Number of pages10
JournalEndocrine Practice
Volume19
Issue number1
DOIs
StatePublished - Jan 2013

Fingerprint

Hyperglycemia
Intravenous Administration
Intensive Care Units
Glucose
Nausea
exenatide
Hypoglycemia
Vomiting
iodonitrotetrazolium
Insulin
Safety

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Medicine(all)

Cite this

Management of hyperglycemia with the administration of intravenous exenatide to patients in the cardiac intensive care unit. / Abuannadi, Mohammad; Kosiborod, Mikhail; Riggs, Lisa; House, John A.; Hamburg, Mitchell S.; Kennedy, Kevin F.; Marso, Steven P.

In: Endocrine Practice, Vol. 19, No. 1, 01.2013, p. 81-90.

Research output: Contribution to journalArticle

Abuannadi, Mohammad ; Kosiborod, Mikhail ; Riggs, Lisa ; House, John A. ; Hamburg, Mitchell S. ; Kennedy, Kevin F. ; Marso, Steven P. / Management of hyperglycemia with the administration of intravenous exenatide to patients in the cardiac intensive care unit. In: Endocrine Practice. 2013 ; Vol. 19, No. 1. pp. 81-90.
@article{057dc3f643a04166b1448742d684993f,
title = "Management of hyperglycemia with the administration of intravenous exenatide to patients in the cardiac intensive care unit",
abstract = "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, nonrandomized pilot study. Forty patients admitted to the CICU with glucose levels of 140 to 400 mg/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 to 119 mg/dL (n = 84) and the other (MOD) with a target of 100 to 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<.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 = .15), but lower in the INT group (105.0 mg/dL [92.0, 128.0], P<.001 for exenatide versus 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 the MOD group (P<.001) and 3.0 hours (1.0, 5.0) in the INT group (P = .80 for exenatide versus 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 patients 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.",
author = "Mohammad Abuannadi and Mikhail Kosiborod and Lisa Riggs and House, {John A.} and Hamburg, {Mitchell S.} and Kennedy, {Kevin F.} and Marso, {Steven P.}",
year = "2013",
month = "1",
doi = "10.4158/EP12196.OR",
language = "English (US)",
volume = "19",
pages = "81--90",
journal = "Endocrine Practice",
issn = "1530-891X",
publisher = "American Association of Clinical Endocrinology",
number = "1",

}

TY - JOUR

T1 - Management of hyperglycemia with the administration of intravenous exenatide to patients in the cardiac intensive care unit

AU - Abuannadi, Mohammad

AU - Kosiborod, Mikhail

AU - Riggs, Lisa

AU - House, John A.

AU - Hamburg, Mitchell S.

AU - Kennedy, Kevin F.

AU - Marso, Steven P.

PY - 2013/1

Y1 - 2013/1

N2 - 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, nonrandomized pilot study. Forty patients admitted to the CICU with glucose levels of 140 to 400 mg/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 to 119 mg/dL (n = 84) and the other (MOD) with a target of 100 to 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<.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 = .15), but lower in the INT group (105.0 mg/dL [92.0, 128.0], P<.001 for exenatide versus 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 the MOD group (P<.001) and 3.0 hours (1.0, 5.0) in the INT group (P = .80 for exenatide versus 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 patients 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.

AB - 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, nonrandomized pilot study. Forty patients admitted to the CICU with glucose levels of 140 to 400 mg/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 to 119 mg/dL (n = 84) and the other (MOD) with a target of 100 to 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<.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 = .15), but lower in the INT group (105.0 mg/dL [92.0, 128.0], P<.001 for exenatide versus 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 the MOD group (P<.001) and 3.0 hours (1.0, 5.0) in the INT group (P = .80 for exenatide versus 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 patients 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.

UR - http://www.scopus.com/inward/record.url?scp=84881507609&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84881507609&partnerID=8YFLogxK

U2 - 10.4158/EP12196.OR

DO - 10.4158/EP12196.OR

M3 - Article

C2 - 23186969

AN - SCOPUS:84881507609

VL - 19

SP - 81

EP - 90

JO - Endocrine Practice

JF - Endocrine Practice

SN - 1530-891X

IS - 1

ER -