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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EIntravenous (IV) insulin is currently the standard of care but requires frequent monitoring and can cause excess hypoglycemia. This article presents results from a pilot study to determine the feasibility, efficacy, and safety of IV exenatide in hyperglycemic cardiac intensive care unit patients [Intravenous Exenatide in Coronary Intensive Care Unit Patients; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00736229\u0026amp;atom=%2Fspmdc%2F11%2F8%2F10.atom\u0022\u003ENCT00736229\u003C\/a\u003E].\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EInsulin\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes Mellitus\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EDiabetes \u0026amp; Endocrinology Clinical Trials\u003C\/li\u003E\u003C\/ul\u003E\u003Cp id=\u0022p-2\u0022\u003EIn critically ill patients, persistent hyperglycemia is associated with increased mortality and complications [Kosiborod M et al. \u003Cem\u003ECirculation\u003C\/em\u003E 2005], but low blood glucose is equally dangerous [Marik P. \u003Cem\u003EWorld J Gastrointest Surg\u003C\/em\u003E 2009]. Intravenous (IV) insulin is currently the standard of care but requires frequent monitoring and can cause excess hypoglycemia. Steven P. Marso, St. Luke\u0027s Mid America Heart \u0026amp; Vascular Institute, Kansas City, Missouri, USA, presented results from a pilot study to determine the feasibility, efficacy, and safety of IV exenatide in hyperglycemic cardiac intensive care unit (CICU) patients [Intravenous Exenatide in Coronary Intensive Care Unit Patients; \u003Ca class=\u0022external-ref external-ref-type-clintrialgov\u0022 href=\u0022\/lookup\/external-ref?link_type=CLINTRIALGOV\u0026amp;access_num=NCT00736229\u0026amp;atom=%2Fspmdc%2F11%2F8%2F10.atom\u0022\u003ENCT00736229\u003C\/a\u003E].\u003C\/p\u003E\u003Cp id=\u0022p-3\u0022\u003EDr. Marso and his colleagues performed a prospective, single-center, open-label, nonrandomized study that compared IV exenatide to insulin controls. The primary outcome measure was average glucose value during a coronary ICU stay of 24 to 48 hours. Secondary outcome measures included number of hypoglycemic episodes in the ICU, number of subjects with \u0026gt;1 ICU hypoglycemic episode or serious adverse event (death, life-threatening event, prolonged hospital stay, disability or incapacity, non-life-threatening event) within 30 days of the discontinuation of the study drug.\u003C\/p\u003E\u003Cp id=\u0022p-4\u0022\u003EEligibility criteria included age \u0026gt;18 years; admission to the CICU; admission blood glucose (BG) of 140 to 400 mg\/dL; primary cardiovascular diagnosis by the attending physician; being under the primary care of the cardiology service; ventilator independence; and the ability to provide informed consent. Exclusion criteria included creatinine clearance \u0026lt;30 mL\/min, type 1 diabetes, pregnancy, gastroparesis, insulin treatment (except monotherapy for long-acting basal insulin), admittance to the CICU to measure hemodynamics prior to transplant, or posttransplant procedure.\u003C\/p\u003E\u003Cp id=\u0022p-5\u0022\u003EExenatide was infused at a fixed dose of 0.05 mcg\/min (30-min bolus), then 0.025 mcg\/min continuously for 24 to 48 hrs. The drug was benchmarked to 2 insulin control groups: 1) intensive (INT; target BG 90 to 119 mg\/dL) and 2) modified (MOD; target BG 100 to 140 mg\/dL). Exenatide was infused in 40 patients (age 65 years, 83% male, 63% acute coronary syndromes, 75% type 2 diabetes). Admission BG was 199.3\u00b152.7 mg\/dL in exenatide patients and 240.3\u00b144.0 mg\/dL in the MOD group (p=0.02). Time to target BG was lower in the exenatide than MOD group (3.9\u00b14.3 vs 9.3\u00b17.4 hours; p\u0026lt;0.001; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E). Drug-related nausea occurred in 8 (20%) exenatide patients; 5 (13%) discontinued use early. Exenatide was associated with a lower BG than MOD.\u003C\/p\u003E\u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/10\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Mean Glucose: 3 Groups.\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1513088814\u0022 data-figure-caption=\u0022Mean Glucose: 3 Groups.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/10\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/10\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/11\/8\/10\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/12535\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n            \u003Cp id=\u0022p-6\u0022 class=\u0022first-child\u0022\u003EMean Glucose: 3 Groups.\u003C\/p\u003E\n         \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EReproduced with permission from S. Marso, MD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cp id=\u0022p-7\u0022\u003EOf 668 and 745 glucose observations in the exenatide and MOD groups, respectively, there were numerically fewer overall hypoglycemic episodes in the exenatide group (0.9% vs 1.2%; p=0.57), including severe events (0% vs 0.3%; p=0.18). BG in exenatide-treated patients was more frequently within the target range (100 to 140 mg\/dL; 37% vs 29%; p\u0026lt;0.001) and within 71 to 140 mg\/dL (48% vs 39%; p\u0026lt;0.001) compared with MOD. No serious adverse events were observed in the exenatide group.\u003C\/p\u003E\u003Cp id=\u0022p-8\u0022\u003EThe study objective was to determine the feasibility, efficacy, and safety of glucose-lowering with IV exenatide monotherapy in hyperglycemic patients who were admitted to the CICU. The findings suggest that fixed-dose IV exenatide is feasible in hyperglycemic ICU patients, achieves similar efficacy compared with IV insulin, and does not cause severe hypoglycemia.\u003C\/p\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2011 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/11\/8\/10.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzn132\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzn132\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}