A randomised controlled trial comparing perioperative intravenous insulin, GIK or GLP-1 treatment in patients with diabetes u2013 PILGRIM trial

Abstract Objective: We investigated whether preoperative administration of liraglutide improved perioperative glucose control and reduced insulin requirements when compared to an intraoperative glucose-insulin-potassium infusion or an intravenous insulin bolus regimen. Research Design and Methods: This was a multicenter open-label randomized controlled trial. Patients with diabetes type 2 undergoing non-cardiac surgery were eligible. Patients were randomized to premedication with liraglutide (LG) with rescue insulin as needed, an infusion with glucose-insulin-potassium (GIK) or a bolus regimen (BR) targeting for glucose < 144 mg/dl. The main outcome was the between group difference in median postoperative glucose one hour after surgery. Secondary outcomes included insulin requirements per treatment group, incidence of hypoglycemia and postoperative complications.Results: We analyzed 150 patients according to the intention to treat principle. Median plasma glucose was significantly lower one hour postoperatively in the LG group compared to the GIK and BR groups (119 mg/dl [101 u2013 139] vs. 135 mg/dl [115 u2013 149], p=0.026 and 137 mg/dl [115 u2013 160], p=0.006 respectively). In the LG group, 48% of the patients received a corrective bolus of insulin during the trial, as compared to 74% and 72% of the patients in the GIK and BR group, respectively (p=0.014). The incidence of hypoglycemia and postoperative complications did not differ between the groups. The incidence of preoperative nausea was increased in the LG group (12.8% versus 0%, p=0.007). Conclusions: Preoperative administration of liraglutide improved perioperative glycemic control at the cost of slightly increased preoperative nausea rates, with a reduction in insulin requirements. GLP-1 treatment seems valuable in the perioperative treatment of patients with diabetes.