Academic Journal
GLP-1 Receptor Agonists and Insulin Versus Insulin for Perioperative Glycemic Control in Patients with Type 2 Diabetes Undergoing Cardiac Surgery: A Systematic Review.
| Τίτλος: | GLP-1 Receptor Agonists and Insulin Versus Insulin for Perioperative Glycemic Control in Patients with Type 2 Diabetes Undergoing Cardiac Surgery: A Systematic Review. |
|---|---|
| Συγγραφείς: | Hassan D; Department of Medicine, Dow University of Health Sciences, Dow Medical College, Karachi, Pakistan., Shakeel R; Department of Medicine, Dow University of Health Sciences, Dow Medical College, Karachi, Pakistan., Qaisi W; Department of Medicine, An-Najah National University, Nablus, Palestine., Ahmed SR; Department of Medicine, Dow University of Health Sciences, Dow Medical College, Karachi, Pakistan., Taj J; Department of Medicine, Dow University of Health Sciences, Dow Medical College, Karachi, Pakistan., Adi M; Faculty of Medicine, Damascus University, Damascus, Syria., Ahmed AY; KFS University, Faculty of Medicine and Rehabilitation / Intern Student, Egypt., Abuzahra A; Faculty of Medicine, Hebron University, Hebron, Palestine., Sajid EU; Department of Medicine, Dow University of Health Sciences, Dow Medical College, Karachi, Pakistan., Khan HA; Department of Medicine, Al-Tibri Medical College, Isra University, Karachi, Pakistan., Basit T; Department of Medicine, Dow University of Health Sciences, Dow Medical College, Karachi, Pakistan., Iqbal J; Department of Nursing, Hamad Medical Corporation, Doha, Qatar., Hussain A; Department of Internal Medicine, Chitwan Medical College, Bharatpur, Nepal. |
| Πηγή: | Annals of cardiac anaesthesia [Ann Card Anaesth] 2026 Oct 01; Vol. 29 (4), pp. 464-470. Date of Electronic Publication: 2026 Oct 12. |
| Τύπος έκδοσης: | Journal Article; Systematic Review |
| Γλώσσα: | English |
| Στοιχεία περιοδικού: | Publisher: Medknow Country of Publication: India NLM ID: 9815987 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 0974-5181 (Electronic) Linking ISSN: 09719784 NLM ISO Abbreviation: Ann Card Anaesth Subsets: MEDLINE |
| Imprint Name(s): | Publication: <2008-> : Mumbai : Medknow Original Publication: [New Delhi : Indian Association of Cardiovascular Thoracic Anaesthesiologists |
| Ιατρικοί όροι (MeSH): | Diabetes Mellitus, Type 2*/drug therapy , Diabetes Mellitus, Type 2*/complications , Insulin*/therapeutic use , Hypoglycemic Agents*/therapeutic use , Glycemic Control*/methods , Cardiac Surgical Procedures*/methods , Perioperative Care*/methods , Glucagon-Like Peptide-1 Receptor Agonists*, Blood Glucose/drug effects ; Liraglutide/therapeutic use ; Hyperglycemia/drug therapy ; Humans |
| Περίληψη: | Abstract: Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing cardiac surgery and is linked to adverse outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer glucose-dependent insulinotropic effects and potential cardiac benefits, but their perioperative role remains uncertain. This review evaluated the efficacy and safety of GLP-1 RA therapy as an adjunct to insulin in this setting. Three electronic databases (PubMed, Cochrane, and Google Scholar) were searched for relevant articles up to October 2025. The primary endpoint was blood glucose levels during the perioperative period, while secondary endpoints included hypoglycemia incidence, total insulin requirement, time in target glucose range, and postoperative complications. Three randomized controlled trials (RCTs) including 168 patients with type 2 diabetes undergoing cardiac surgery were assessed. Perioperative use of liraglutide (subcutaneously in doses of 0.6-1.8 mg/day) was associated with preliminary evidence of improved glycemic control across preoperative, intraoperative, and early postoperative periods, including lower glucose levels, reduced glycemic variability, and fewer insulin adjustments, with a low incidence of hypoglycemia. However, heterogeneity in dosing, timing, and monitoring protocols across studies limits direct comparisons. Mild gastrointestinal adverse events, such as nausea and vomiting, were more frequent with liraglutide. One study reported exploratory immunometabolic effects in adipose tissue. Preliminary evidence from these heterogeneous studies suggests that adding liraglutide to insulin may improve perioperative glycemic control compared to insulin or placebo in patients with type 2 diabetes undergoing cardiac surgery. However, findings are limited by the small number of studies, methodological variability, and lack of long-term outcomes, necessitating larger, standardized trials. (Copyright © 2026 Annals of Cardiac Anaesthesia.) |
| References: | Padhi S, Nayak AK, Behera A. Type II diabetes mellitus: A review on recent drug based therapeutics. Biomed Pharmacother 2020;131:110708. Lovic D, Piperidou A, Zografou I, Grassos H, Pittaras A, Manolis A. The growing epidemic of diabetes mellitus. Curr Vasc Pharmacol 2020;18:104–9. Zheng Y, Ley SH, Hu FB. Global aetiology and epidemiology of type 2 diabetes mellitus and its complications. Nat Rev Endocrinol 2018;14:88–98. Drucker DJ. Mechanisms of action and therapeutic application of glucagon-like peptide-1. Cell Metab 2018;27:740–56. Zheng Z, Zong Y, Ma Y, Tian Y, Pang Y, Zhang C, et al. Glucagon-like peptide-1 receptor: Mechanisms and advances in therapy. Signal Transduct Target Ther 2024;9:234. Wookey O, Galligan A, Wilkie B, MacIsaac A, Paratz E. Perioperative use of GLP-1 receptor agonists in patients undergoing cardiac procedures: a scoping review. Heart Lung Circ 2025;34:105–17. Hulst AH, Plummer MP, Hollmann MW, DeVries JH, Preckel B, Deane AM, et al. Systematic review of incretin therapy during peri-operative and intensive care. Crit Care 2018;22:299. Klein SR, Hobai IA. Semaglutide, delayed gastric emptying, and intraoperative pulmonary aspiration: a case report. Can J Anaesth 2023;70:1394–6. Beam WB, Hunter Guevara LR. Are serious anesthesia risks of semaglutide and other GLP-1 agonists under-recognized? Case reports of retained solid gastric contents in patients undergoing anesthesia. APSF Newsletter. 2023;38:67,69–71. Ushakumari DS, Sladen RN. ASA consensus-based guidance on preoperative management of patients on glucagon-like peptide-1 receptor agonists. Anesthesiology 2024;140:346–8. Jeppsson A, Rocca B, Hansson EC, Gudbjartsson T, James S, Kaski JC, et al. 2024 EACTS Guidelines on perioperative medication in adult cardiac surgery. Eur J Cardiothorac Surg 2024;67:ezae355. Makino H, Tanaka A, Asakura K, Koezuka R, Tochiya M, Ohata Y, et al. Addition of low-dose liraglutide to insulin therapy is useful for glycaemic control during the peri-operative period: effect of glucagon-like peptide-1 receptor agonist therapy on glycaemic control in patients undergoing cardiac surgery (GLOLIA study). Diabet Med. 2019;36:1621–8. Sindhvananda W, Poopuangpairoj W, Jaiprasat T, Ongcharit P. Comparison of glucose control by added liraglutide to only insulin infusion in diabetic patient undergoing cardiac surgery: a preliminary randomized-controlled trial. Ann Card Anaesth 2023;26:63–71. Iacobellis G, Goldberger JJ, Lamelas J, Martinez CA, Sterling CM, Bodenstab M, et al. Liraglutide effects on epicardial adipose tissue micro-RNAs and intra-operative glucose control. Nutr Metab Cardiovasc Dis 2025;35:103726. Lazar HL, McDonnell M, Chipkin SR, Furnary AP, Engelman RM, Sadhu AR, et al. The Society of Thoracic Surgeons practice guideline series: blood glucose management during adult cardiac surgery. Ann Thorac Surg 2009;87:663–9. Dungan KM, Braithwaite SS, Preiser JC. Stress hyperglycaemia. Lancet. 2009;373:1798–1807. El-Boghdadly K, Dhesi J, Fabb P, Levy N, Lobo DN, McKechnie A, et al. Elective peri-operative management of adults taking glucagon-like peptide-1 receptor agonists, glucose-dependent insulinotropic peptide agonists and sodium-glucose cotransporter-2 inhibitors: a multidisciplinary consensus statement. Anaesthesia 2025;80:412–24. van den Berghe G, Wouters P, Weekers F, Verwaest C, Bruyninckx F, Schetz M, et al. Intensive insulin therapy in critically ill patients. N Engl J Med 2001;345:1359–67. Fayfman M, Galindo RJ, Rubin DJ, Mize DL, Anzola I, Urrutia MA, et al. A randomized controlled trial on the safety and efficacy of exenatide therapy for the inpatient management of general medicine and surgery patients with type 2 diabetes. Diabetes Care. 2019;42:450–6. do Nascimento TS, Pereira ROL, Maia E, Ohnuma T, da Costa MG, Slawka E, et al. The impact of glucagon-like peptide-1 receptor agonists in the patients undergoing anesthesia or sedation: systematic review and meta-analysis. Perioper Med (Lond) 2024;13:78. Monnier L, Lapinski H, Colette C. Contributions of fasting and postprandial plasma glucose increments to the overall diurnal hyperglycemia of type 2 diabetic patients: variations with increasing levels of HbA1c. Diabetes Care 2003;26:881–5. Gandhi GY, Nuttall GA, Abel MD, Mullany CJ, Schaff HV, Williams BA, et al. Intraoperative hyperglycemia and perioperative outcomes in cardiac surgery patients. Mayo Clin Proc 2005;80:862–6. Krinsley JS. Glycemic variability: a strong independent predictor of mortality in critically ill patients. Crit Care Med 2008;36:3008–13. Nauck MA, Vilsbøll T, Gallwitz B, Garber A, Madsbad S. Incretin-based therapies: viewpoints on the way to consensus. Diabetes Care. 2009;32(Suppl 2):S223–31. Todi S, Bhattacharya M. Glycemic variability and outcome in critically ill. Indian J Crit Care Med 2014;18:285–90. Li FF, Jiang L, Fu L, Zhu HH, Zhou P, Zhang D, et al. Exenatide add-on to continuous subcutaneous insulin infusion therapy reduces bolus insulin doses in patients with type 2 diabetes: a randomized, controlled, open-label trial. Diabetes Ther 2017;8:177–87. Marso SP, Daniels GH, Brown-Frandsen K, Kristensen P, Mann JF, Nauck MA, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016;375:311–22. Alharbi SH. Anti-inflammatory role of glucagon-like peptide 1 receptor agonists and its clinical implications. Ther Adv Endocrinol Metab 2024;15:20420188231222367. |
| Contributed Indexing: | Keywords: Cardiac surgery; GLP-1 receptor agonist; glycemic control; insulin; liraglutide; perioperative management; type 2 diabetes |
| Substance Nomenclature: | 0 (Glucagon-Like Peptide-1 Receptor Agonists) 0 (Insulin) 0 (Hypoglycemic Agents) 0 (Blood Glucose) 839I73S42A (Liraglutide) |
| Entry Date(s): | Date Created: 20261012 Date Completed: 20261012 Latest Revision: 20261014 |
| Update Code: | 20261015 |
| DOI: | 10.4103/aca.aca_307_25 |
| PMID: | 42862661 |
| Βάση Δεδομένων: | MEDLINE |
| ISSN: | 0974-5181 |
|---|---|
| DOI: | 10.4103/aca.aca_307_25 |