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.
  
  
  CONCLUSIONS
  Intravenous exenatide is effective in lowering glucose levels in CICU patients, but its use may be limited by nausea.
authors.affiliation: Saint Luke's Mid America Heart Institute University of Missouri-Kansas City, Kansas City, MO 64111, USA.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abuannadi
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
authors.forename: Lisa
authors.initials: L
authors.lastname: Riggs
authors.forename: John A
authors.initials: JA
authors.lastname: House
authors.forename: Mitchell S
authors.initials: MS
authors.lastname: Hamburg
authors.forename: Kevin F
authors.initials: KF
authors.lastname: Kennedy
authors.forename: Steven P
authors.initials: SP
authors.lastname: Marso
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001786:Blood Glucose; D000077270:Exenatide; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D010455:Peptides / Q000008:administration & dosage / Q000627:therapeutic use*; D010865:Pilot Projects; D011446:Prospective Studies; D016896:Treatment Outcome; D014688:Venoms / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D001786:Blood Glucose; D007004:Hypoglycemic Agents; D007328:Insulin; D010455:Peptides; D014688:Venoms; D000077270:Exenatide