Hyperglycemia Stress Clinical Trial
Official title:
Perioperative Stress Hyperglycemia in General and Vascular Surgery Patients
Hyperglycemia is seen in approximately 30% of patients who do not have a history of diabetes and undergo general surgery. Hyperglycemia in this setting is associated with increased risk of postoperative complications. The purpose of this study is to investigate risk factors for developing high sugars during the time of surgery, and if these high sugars can be prevented by the use of an injectable diabetes medication (dulaglutide) prior to surgery.
Status | Recruiting |
Enrollment | 245 |
Est. completion date | May 30, 2026 |
Est. primary completion date | May 30, 2025 |
Accepts healthy volunteers | No |
Gender | All |
Age group | 45 Years to 80 Years |
Eligibility | Inclusion criteria (Aim 1): - Men and women between the ages of 45 and 80 years undergoing non-cardiac general or vascular surgery - BMI =30 kg/m^2 without a previously known history of DM Inclusion criteria (Aim 2): - Men and women without known history of diabetes with ages between 45 and 80 years undergoing non-cardiac general or vascular surgery participating in Aim 1. - BMI =30 kg/m2 and pre-DM or DM by OGTT or HbA1c. Exclusion criteria (Aim 1): - Patients prescribed or taking antihyperglycemic medications - Patients undergoing cardiac surgery or patients anticipated to require ICU care - Patients expected to be admitted less than 48-72 hours after surgery - Severely impaired renal function (eGFR < 30 mL/min) or clinically significant hepatic failure - Treatment with oral (equivalent to prednisone > 5 mg/day) or injectable corticosteroids - Mental condition rendering the subject unable to understand the nature, scope, and possible consequences of the study; unable to consent - Pregnant or breast feeding at time of enrollment - Prisoners Exclusion criteria (Aim 2): - Same as in Aim 1, with the following additional exclusion criteria: - Patients undergoing gastrointestinal surgery or at high risk for gastrointestinal obstruction/ileus or expected to require gastrointestinal suction - Patients with delayed gastric emptying, pancreatic or gallbladder disease - Patients with personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 (MEN2) |
Country | Name | City | State |
---|---|---|---|
United States | Emory University Hospital | Atlanta | Georgia |
United States | Grady Hospital | Atlanta | Georgia |
Lead Sponsor | Collaborator |
---|---|
Emory University | National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Institutes of Health (NIH) |
United States,
Type | Measure | Description | Time frame | Safety issue |
---|---|---|---|---|
Primary | Incidence of stress hyperglycemia (SH) | Incidence of stress hyperglycemia will be determine in a population at high-risk for perioperative dysglycemia among participants in Aim 1. | Up to 14 days (depending on length of hospitalization) | |
Primary | Percentage of time in target glucose range (70-140 mg/dL) by CGM | Proportion of time in target glucose range (70-140 mg/dL) by CGM data will be calculated for participants of Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Baseline Insulin Secretion | Baseline insulin secretion between patients with and without stress hyperglycemia will be examined among participants in Aim 1. | Baseline | |
Secondary | Baseline Insulin Sensitivity | Baseline insulin sensitivity between patients with and without stress hyperglycemia will be examined among participants in Aim 1. | Baseline | |
Secondary | Mean Onset of Stress Hyperglycemia (Glucose >140 mg/dL) | Mean onset time of stress hyperglycemia by CGM (glucose >140 mg/dL) during the postoperative period will be examined for participants of Aim 1. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Mean Duration of Stress Hyperglycemia (Glucose >140 mg/dL) | The mean duration of stress hyperglycemia by CGM (glucose >140 mg/dL) during the postoperative period will be examined for participants of Aim 1. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Mean Daily Glucose Values | The mean daily glucose values values, as measured by both point-of-care (POC) glucose testing and CGM data, will be examined among participants in Aim 1. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Maximum Daily Glucose Values | The maximum daily glucose values values, as measured by both POC glucose testing and CGM data, will be examined among participants in Aim 1. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Total Daily Insulin Dose | The total daily insulin dose in patients with and without stress hyperglycemia will be examined among participants in Aim 1. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Length of Hospital Stay | The length of hospital stay (in days) in patients with and without stress hyperglycemia will be examined among participants in Aim 1. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Number of ICU Transfers | The number of ICU transfers in patients with and without stress hyperglycemia will be examined among participants in Aim 1. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Number of Hospital Readmissions After Discharge | Number of hospital readmissions after discharge patients with and without stress hyperglycemia (SH) will be examined among participants in Aim 1. | Up to 3 months after discharge | |
Secondary | Number of Emergency Room Visits After Discharge | The number of emergency room visits after discharge patients with and without stress hyperglycemia (SH) will be examined among participants in Aim 1. | Up to 3 months after discharge | |
Secondary | Number of Participants Experiencing Complications | A composite of complications including wound infection, respiratory failure, pneumonia, acute kidney injury (increase in creatinine by 0.5 mg/dL), and major adverse cardiac events (MACE) will be examined among participants in Aim 1. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Percentage of Time in Hyperglycemia (Glucose>140 mg/dL) | The percentage of time in hyperglycemia with glucose>140 mg/dL will be examined for participants of Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Percentage of Time in Hyperglycemia (Glucose>180 mg/dL) | The percentage of time in hyperglycemia with glucose>180 mg/dL will be examined for participants of Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Percentage of Time in Hypoglycemia (Glucose <70 mg/dL) | The percentage of time in hypoglycemia with glucose <70 mg/dL will be examined for participants of Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Percentage of Time in Hypoglycemia (Glucose <54 mg/dL) | The percentage of time in hypoglycemia with glucose <54 mg/dL will be examined for participants of Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Percentage of Time in Hypoglycemia (Glucose <40 mg/dL) | The percentage of time in hypoglycemia with glucose <40 mg/dL will be examined for participants of Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Mean Onset of Stress Hyperglycemia During the Postoperative Period | The mean onset time of stress hyperglycemia during the postoperative period by CGM data will be examined for participants of Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Mean Duration of Stress Hyperglycemia During the Postoperative Period | The mean duration of stress hyperglycemia during the postoperative period by CGM data will be examined for participants of Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Mean Daily Glucose Values (Aim 2) | The mean daily glucose values values, as measured by both POC glucose testing and CGM data, will be examined among participants in Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Maximum Daily Glucose Values (Aim 2) | The maximum daily glucose values values, as measured by both POC glucose testing and CGM data, will be examined among participants in Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Perioperative Insulin Requirements | Perioperative insulin requirements will be assessed as the total daily insulin dose, among participants from Aim 2. | Up to 14 days (depending on length of hospitalization) | |
Secondary | Change in Plasma Cortisol Level | Samples will be collected prior to surgery and 48 to 72 hours after surgery to assess inflammatory and oxidative stress biomarkers. | Baseline, 48 to 72 hours postoperatively | |
Secondary | Change in Level of Free Fatty Acids (FFA) | Samples will be collected prior to surgery and 48 to 72 hours after surgery to assess inflammatory and oxidative stress biomarkers. | Baseline, 48 to 72 hours postoperatively | |
Secondary | Change in High Sensitivity C-reactive Protein (hsCRP) Level | Samples will be collected prior to surgery and 48 to 72 hours after surgery to assess inflammatory and oxidative stress biomarkers. | Baseline, 48 to 72 hours postoperatively | |
Secondary | Change in Tumor Necrosis Factor-alpha (TNF-a) Level | Samples will be collected prior to surgery and 48 to 72 hours after surgery to assess inflammatory and oxidative stress biomarkers. | Baseline, 48 to 72 hours postoperatively | |
Secondary | Change in Adiponectin Level | Samples will be collected prior to surgery and 48 to 72 hours after surgery to assess inflammatory and oxidative stress biomarkers. | Baseline, 48 to 72 hours postoperatively | |
Secondary | Change in Level of Thiobarbituric Acid Reactive Substances (TBARS) | Samples will be collected prior to surgery and 48 to 72 hours after surgery to assess inflammatory and oxidative stress biomarkers. | Baseline, 48 to 72 hours postoperatively |
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