Intravenous Exenatide in Coronary Intensive Care Unit (ICU) Patients

Saint Luke's Health System40 enrolled

Overview

The purpose of this study is to determine the efficacy of intravenous Exenatide therapy in hyperglycemic patients admitted to the coronary intensive care unit.

Diabetic patients with acute myocardial infarction (MI) have particularly poor outcomes. Clinical practice guidelines from the American College of Cardiology/American Heart Association for the treatment of patients with acute coronary syndromes call for treatment to achieve preprandial glucose \<110 mg/dL, a maximum daily target \<180 mg/dL, and a post-discharge hemoglobin A1c \<7%. Initiation of aggressive insulin therapy is also warranted to achieve blood glucose \<150 mg/dL during days 0-3 and 80-110 mg/dL when possible thereafter. To date, no studies have been conducted assessing the efficacy of intravenous exenatide administration on achieving glucose lowering in hyperglycemic coronary ICU patients.

Study Type

INTERVENTIONAL

Allocation

Purpose

TREATMENT

Masking

NONE

Enrollment

Conditions

Hyperglycemia Acute Coronary Syndromes Myocardial Infarction

Interventions

ExenatideDRUG

0.05 µg/min bolus of open-label exenatide followed by a constant infusion of 0.025 µg/min for 24-48 hours

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Admission to coronary ICU * Admission blood glucose 140-299 mg/dL * Primary cardiovascular diagnosis by attending physician * Under primary care of cardiology service * Age \> 18 years old * Ventilator independent * Able to provide informed consent Exclusion Criteria: * Admission blood glucose \< 140 or \> 300 mg/dL * Ventilator dependent * Unconscious sedation * Type 1 diabetes * Known pregnancy * Admitted to coronary ICU for right heart cath to measure hemodynamics prior to transplant * Post transplant procedure * Currently enrolled in another clinical trial * Unable to provide informed consent * Creatinine clearance \< 30 mL/min * On insulin treatment except for monotherapy with long-acting basal insulin (e.g., insulin glargine \[Lantus®\] or detemir \[Levemir®\]) * Gastroparesis

Locations (1)

Mid America Heart Institute Saint Luke's Health System

Kansas City, Missouri, United States

Outcomes

Primary Outcomes

Median Glucose Values From Steady State Through 48 Hours or Until Discharge.

Time to steady state was defined as the time from the initiation of drug infusion to first glucose value that is ≤140 mg/dl. Median glucose values were then calculated for each patient from the start of steady state through 48 hours or until discharge.

Time frame: 1-48 hours

Time to Steady State

Time to steady state was defined as the time from the initiation of drug infusion (Exenatide or Insulin) to first glucose value that is ≤140 mg/dl.

Time frame: Start of infusion through 48 hours or until discharge

Secondary Outcomes

Rates of Hypoglycemia and Severe Hypoglycemia

Total number of patients having at least one hypoglycemic episode (blood glucose less than 70 mg/dl), including episodes classified as severe (blood glucose less than 50 mg/dl)

Time frame: 1-48 hours

Serious Adverse Events (Death, Non-fatal Myocardial Infarction, and Non-fatal Stroke Through 30 Days)

Time frame: 30 days

Data from ClinicalTrials.gov

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