Metabolic Phenotyping During Stress Hyperglycemia in Cardiac Surgery Patients

Stress hyperglycemia is common in the perioperative period and is associated with increased risk of death postoperatively. Counterregulatory hormones and inflammatory mediators appear to modulate the acute biological response to stress, however, the pathophysiological pathways that result in stress hyperglycemia and its link to poor clinical outcomes are not well understood. At least half of non‐diabetes mellitus (DM) patients undergoing cardiac surgery develop stress hyperglycemia shown to be an independent risk factor of morbidity and mortality. The current approach to treat hyperglycemia with insulin has major limitations including high resource utilization and high risk of hypoglycemia. The main goals of this study are to examine baseline and postoperative metabolic profiles of non‐diabetic, coronary artery bypass grafting (CABG) patients with stress hyperglycemia and to study the effect of a long‐acting glucagon‐like peptide‐1 receptor agonists (GLP‐1 RA) on the prevention of stress‐hyperglycemia and modulation of metabolic stress during cardiac surgery. To examine whether exposure to dulaglutide, a GLP‐1 RA, can improve glycemic control and ameliorate the inflammatory response to acute surgical stress obese patients without diabetes mellitus undergoing CABG surgery.will be randomized to receive either dulaglutide or placebo two to three days prior to surgery. The study ultimately wants to provide evidence to support the use of novel therapies to prevent and manage stress hyperglycemia in the inpatient setting.