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    Systematic review of incretin therapy during peri-operative and intensive care

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    Author
    Hulst, AH; Plummer, MP; Hollmann, MW; DeVries, JH; Preckel, B; Deane, AM; Hermanides, J
    Date
    2018-11-14
    Source Title
    Critical Care (UK)
    Publisher
    BMC
    University of Melbourne Author/s
    Deane, Adam
    Affiliation
    Medicine and Radiology
    Metadata
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    Document Type
    Journal Article
    Citations
    Hulst, A. H., Plummer, M. P., Hollmann, M. W., DeVries, J. H., Preckel, B., Deane, A. M. & Hermanides, J. (2018). Systematic review of incretin therapy during peri-operative and intensive care. CRITICAL CARE, 22 (1), https://doi.org/10.1186/s13054-018-2197-4.
    Access Status
    Open Access
    URI
    http://hdl.handle.net/11343/253824
    DOI
    10.1186/s13054-018-2197-4
    Abstract
    BACKGROUND: Glucagon-like peptide 1 (GLP-1) and glucose-dependent insulinotropic peptide (GIP) are incretin hormones. By lowering blood glucose in a glucose-dependent manner, incretin-based therapies represent a novel and promising intervention to treat hyperglycaemia in hospital settings. We performed a systematic review of the literature for all current applications of incretin-based therapies in the peri-operative and critical care settings. METHODS: We searched MEDLINE, the Cochrane Library, and Embase databases for all randomised controlled trials using exogenous GLP-1, GLP-1 receptor agonists, exogenous GIP and dipeptidyl peptidase IV inhibitors in the setting of adult peri-operative care or intensive care. We defined no comparator treatment. Outcomes of interest included blood glucose, frequency of hypoglycaemia and insulin administration. RESULTS: Of the 1190 articles identified during the initial literature search, 38 fulfilled criteria for full-text review, and 19 single-centre studies were subsequently included in the qualitative review. Of the 18 studies reporting glycaemic control, improvement was reported in 15, defined as lower glucose concentrations in 12 and as reduced insulin administration (with similar glucose concentrations) in 3. Owing to heterogeneity, meta-analysis was possible only for the outcome of hypoglycaemia. This revealed an incidence of 7.4% in those receiving incretin-based therapies and 6.8% in comparator groups (P = 0.94). CONCLUSIONS: In small, single-centre studies, incretin-based therapies lowered blood glucose and reduced insulin administration without increasing the incidence of hypoglycaemia. TRIAL REGISTRATION: PROSPERO, CRD42017071926.

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