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| ID | Type | Description | Link |
|---|---|---|---|
| 1K23GM128221-01A1 | U.S. NIH Grant/Contract | View source |
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The study was terminated following the Data and Safety Monitoring Board (DSMB) review due to concerns with perioperative use of the study drug.
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| Name | Class |
|---|---|
| National Institute of General Medical Sciences (NIGMS) | NIH |
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This study is a prospective randomized study to examine the effects of exposure to dulaglutide on the prevention of stress-hyperglycemia and the metabolic inflammatory response in the perioperative period.
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 researchers of this study ultimately want to provide evidence to support the use of novel therapies to prevent and manage stress hyperglycemia in the inpatient setting.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Dulaglutide Arm | Experimental | Participants without a history of DM who are randomized to receive a single injection of dulaglutide (0.75 mg/0.5 mL solution in a single-dose pen) one to three days prior to surgery. |
|
| Placebo Arm | Placebo Comparator | Participants without a history of DM who are randomized to receive a single injection of a placebo (saline injection of 0.5 mL pre-drawn solution) one to three days prior to surgery. |
|
| Name | Type | Description | Arm Group Labels | Other Names |
|---|---|---|---|---|
| Dulaglutide Injection | Drug | Participants randomized at pre-surgery/anesthesia visit and without a history of DM will receive a single injection of Dulaglutide injection: 0.75 mg/0.5 mL solution in a single-dose pen 1 to 3 days prior to surgery |
| Measure | Description | Time Frame |
|---|---|---|
| Number of Participants With Blood Glucose Levels (BG) > 140 mg/dl During Post Operative Period | Stress-hyperglycemia is defined as any post-CABG hospital-obtained blood glucose (BG) levels >140 milligrams per deciliter (mg/dL). Information on BG measurements was collected both at bedside by glucose meter and by hospital laboratory. BG was measured every 1-2 hours during continuous insulin infusion (CII) in the ICU, and before meals and at bedtime after transition to regular wards. | During the hospital stay (up to 12 days postoperatively) |
| Measure | Description | Time Frame |
|---|---|---|
| Mean Blood Glucose Levels During the Intensive Care Unit (ICU) Stay Postoperatively | To measure glucose control, the mean blood glucose levels in mg/dL were measured during the postoperative Intensive Care Unit (ICU) stay. Information on BG measurements was collected both at bedside by glucose meter and by hospital laboratory. BG was measured every 1-2 hours during continuous insulin infusion (CII) in the ICU, and before meals and at bedtime after transition to regular wards. |
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Inclusion Criteria:
Exclusion Criteria:
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| Name | Affiliation | Role |
|---|---|---|
| Francisco Pasquel, MD, MPH | Emory University | Principal Investigator |
| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Grady Memorial Hospital | Atlanta | Georgia | 30303 | United States | ||
| Emory Hospital Midtown |
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Participants were recruited from Grady Memorial Hospital, Emory University Hospital Midtown, and Emory University Hospital in Atlanta, Georgia, USA. Participant enrollment began March 8, 2019 and the final study assessment occurred on May 2, 2023.
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| ID | Title | Description |
|---|---|---|
| FG000 | Dulaglutide | Participants without a history of diabetes mellitus (DM) who were randomized to receive a single injection of dulaglutide (0.75 mg/0.5 mL solution in a single-dose pen) one to three days prior to elective coronary artery bypass graft (CABG) surgery. |
| FG001 | Placebo | Participants without a history of DM who were randomized to receive a single injection of a placebo (saline injection of 0.5 mL pre-drawn solution) one to three days prior to elective CABG surgery. |
| Title | Milestones | Reasons Not Completed | ||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Overall Study |
|
|
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| ID | Title | Description |
|---|---|---|
| BG000 | Dulaglutide | Participants without a history of DM who were randomized to receive a single injection of dulaglutide (0.75 mg/0.5 mL solution in a single-dose pen) one to three days prior to surgery. |
| BG001 | Placebo |
| Units | Counts |
|---|---|
| Participants |
|
| Title | Description | Population Description | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Denominator Units Selected | Denominators | Classes |
|---|---|---|---|---|---|---|---|---|---|
| Age, Categorical | Count of Participants |
| Type | Title | Description | Population Description | Reporting Status | Anticipated Posting Date | Parameter Type | Dispersion Type | Unit of Measure | Calculate Percentage | Time Frame | Units Analyzed | Denominator Units Selected | Arm/Group Information | Denominators | Classes | Analyses | |||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Primary | Number of Participants With Blood Glucose Levels (BG) > 140 mg/dl During Post Operative Period | Stress-hyperglycemia is defined as any post-CABG hospital-obtained blood glucose (BG) levels >140 milligrams per deciliter (mg/dL). Information on BG measurements was collected both at bedside by glucose meter and by hospital laboratory. BG was measured every 1-2 hours during continuous insulin infusion (CII) in the ICU, and before meals and at bedtime after transition to regular wards. | This analysis includes participants who completed the study. | Posted | Count of Participants | Participants | During the hospital stay (up to 12 days postoperatively) |
|
Information on adverse events was collected among participants who had elective CABG surgery, beginning at the time of consent and continued through the final assessment occurring 30 days after discharge from the hospital, up to 42 days postoperatively.
Information was collected for the following specific adverse events:sternal wound infection, bacteremia, pneumonia, acute kidney injury, acute myocardial infarction, nausea, vomiting, ileus, and pancreatitis.
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| ID | Title | Description | Deaths (Affected) | Deaths (At Risk) | Serious Events (Affected) | Serious Events (At Risk) | Other Events (Affected) | Other Events (At Risk) |
|---|---|---|---|---|---|---|---|---|
| EG000 | Dulaglutide | Participants without a history of DM who were randomized to receive a single injection of dulaglutide (0.75 mg/0.5 mL solution in a single-dose pen) one to three days prior to surgery. |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Hospital readmission due to nausea and vomitting, acute kidney injury, and dehydration | Renal and urinary disorders | Non-systematic Assessment |
| Term | Organ System | Source Vocabulary | Assessment Type | Notes | Statistical Information |
|---|---|---|---|---|---|
| Nausea | Gastrointestinal disorders | Systematic Assessment |
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| Title | Organization | Phone | Extension | |
|---|---|---|---|---|
| Dr. Francisco J. Pasquel | Emory University | 404-778-1695 | fpasque@emory.edu |
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| Type | Includes Protocol | Includes SAP | Includes ICF | Document Label | Document Date | Document Uploaded Date | Document File Name |
|---|---|---|---|---|---|---|---|
| Prot_SAP | Yes | Yes | No | Study Protocol and Statistical Analysis Plan | Jul 30, 2020 | Apr 27, 2024 | Prot_SAP_001.pdf |
| ICF | No | No | Yes | Informed Consent Form | Jun 21, 2023 | Feb 5, 2024 | ICF_000.pdf |
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| ID | Term |
|---|---|
| D009765 | Obesity |
| ID | Term |
|---|---|
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
| D009750 | Nutritional and Metabolic Diseases |
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| ID | Term |
|---|---|
| C555680 | dulaglutide |
| D012965 | Sodium Chloride |
| ID | Term |
|---|---|
| D002712 | Chlorides |
| D006851 | Hydrochloric Acid |
| D017606 | Chlorine Compounds |
| D007287 | Inorganic Chemicals |
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Prospective placebo controlled randomized study
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|
| Saline Injection | Other | Participants randomized at pre-surgery/anesthesia visit and without a history of DM will receive a single injection of Saline injection/0.5 mL pre-drawn solution 1 to 3 days prior to surgery |
|
|
| During the ICU stay (up to 7 days postoperatively) |
| Number of Participants Needing CII Treatment in the ICU | Patients with two consecutive BG >180 mg/dl, or average daily BG >180 mg/dl were started on rescue therapy with subcutaneous basal insulin (glargine or levemir) once daily. Information on BG measurements was collected both at bedside by glucose meter and by hospital laboratory. BG was measured every 1-2 hours during continuous insulin infusion (CII) in the ICU, and before meals and at bedtime after transition to regular wards. The number of participants needing CII while in the ICU postoperatively was compared between patients randomized to dulaglutide or placebo study arms. | During the ICU stay (up to 7 days postoperatively) |
| Number of Participants With Stress-hyperglycemia Requiring Rescue Therapy With Subcutaneous Insulin After Discontinuation of CII | Patients with two consecutive BG >180 mg/dl, or an average daily BG >180 mg/dl were started on rescue therapy with subcutaneous basal insulin (glargine or levemir) once daily. Information on BG measurements was collected both at bedside by glucose meter and by hospital laboratory. BG was measured every 1-2 hours during continuous insulin infusion (CII) in the ICU, and before meals and at bedtime after transition to regular wards. The number of participants in need of rescue therapy with subcutaneous insulin postoperatively, after CII was discontinued, was compared between study arms. | During the hospital stay (up to 12 days postoperatively) |
| Mean Blood Glucose Levels During the Hospital Stay | To measure glucose control, the mean blood glucose levels in mg/dL during the non-ICU hospital stay postoperatively were measured. Information on BG measurements was collected both at bedside by glucose meter and by hospital laboratory. BG was measured every 1-2 hours during continuous insulin infusion (CII) in the ICU, and before meals and at bedtime after transition to regular wards. | During the hospital stay (up to 12 days postoperatively) |
| Mean Units Per Hour of Insulin While in the ICU | The mean insulin dose during the time that participants were in the ICU is assessed as insulin infusion units per hour. | During the ICU stay (up to 7 days postoperatively) |
| Mean Insulin Dose Per Day While in the ICU | The mean insulin dose during the time that participants were in the ICU is assessed as insulin units per day. | During the ICU stay (up to 7 days postoperatively) |
| Duration of Continuous Insulin Infusion (CII) | The duration of continuous insulin infusion (CII) is assessed in hours. | During the hospital stay (up to 12 days postoperatively) |
| Days of Subcutaneous (SC) Insulin After Discontinuation of CII | Subcutaneous (SC) insulin use after continuous insulin infusion (CII) is discontinued is assessed as the number of days that SC insulin was required. | During the hospital stay (up to 12 days postoperatively) |
| Amount of SC Insulin Administered | The amount of subcutaneous (SC) insulin administered during the ICU and non-ICU hospital stay, among participants requiring SC insulin after discontinuing CII. | During the hospital stay (up to 12 days postoperatively) |
| Number of Participants Experiencing Hyperglycemic Events | Hyperglycemic events are defined as BG > 200 mg/dl, during ICU and non-ICU hospital stay. | During the hospital stay (up to 12 days postoperatively) |
| Number of Participants Experiencing Hypoglycemic Events | Hypoglycemic events are defined as BG <70, < 54, and <40 mg/dl occurring during ICU and non-ICU hospital stay. | During the hospital stay (up to 12 days postoperatively) |
| Number of Participants Experiencing Mortality and Complications | The number of participants experiencing a composite of mortality and complications. Complications include sternal wound infection, bacteremia, pneumonia, acute kidney injury, and acute myocardial infarction. | During the hospital stay (up to 12 days postoperatively) |
| Number of Participants Experiencing Gastrointestinal Adverse Events | The number participants who experienced gastrointestinal adverse events of nausea, vomiting, ileus, pancreatitis. | During the hospital stay (up to 12 days postoperatively) |
| ICU Length of Stay | ICU length of stay is assessed as the mean number of days participants in each study arm spent in the ICU. | During the ICU stay (up to 7 days postoperatively) |
| Hospital Length of Stay | Hospital length of stay is assessed as the mean number of days participants in each study arm spent in the hospital. | During the hospital stay (up to 12 days postoperatively) |
| Number of ICU Readmissions | The number of readmissions to the ICU. | During the hospital stay (up to 12 days postoperatively) |
| Number of Cerebrovascular Events | The number of cerebrovascular events. | During the hospital stay (up to 12 days postoperatively) |
| Participant Mortality | The number of participant deaths while in the ICU and hospital. | During the hospital stay (up to 12 days postoperatively) |
| Atlanta |
| Georgia |
| 30308 |
| United States |
| Emory University Hospital | Atlanta | Georgia | 30322 | United States |
Participants without a history of DM who were randomized to receive a single injection of a placebo (saline injection of 0.5 mL pre-drawn solution) one to three days prior to surgery.
| BG002 | Total | Total of all reporting groups |
| Participants |
|
| Age, Continuous | Mean | Standard Deviation | years |
|
| Sex: Female, Male | Count of Participants | Participants |
|
| Ethnicity (NIH/OMB) | Count of Participants | Participants |
|
| Race (NIH/OMB) | Count of Participants | Participants |
|
| Region of Enrollment | Count of Participants | Participants |
|
| OG001 | Placebo | Participants without a history of DM who were randomized to receive a single injection of a placebo (saline injection of 0.5 mL pre-drawn solution) one to three days prior to surgery. |
|
|
| Secondary | Mean Blood Glucose Levels During the Intensive Care Unit (ICU) Stay Postoperatively | To measure glucose control, the mean blood glucose levels in mg/dL were measured during the postoperative Intensive Care Unit (ICU) stay. Information on BG measurements was collected both at bedside by glucose meter and by hospital laboratory. BG was measured every 1-2 hours during continuous insulin infusion (CII) in the ICU, and before meals and at bedtime after transition to regular wards. | This analysis includes participants who completed the study. | Posted | Mean | Standard Deviation | mg/dL | During the ICU stay (up to 7 days postoperatively) |
|
|
|
| Secondary | Number of Participants Needing CII Treatment in the ICU | Patients with two consecutive BG >180 mg/dl, or average daily BG >180 mg/dl were started on rescue therapy with subcutaneous basal insulin (glargine or levemir) once daily. Information on BG measurements was collected both at bedside by glucose meter and by hospital laboratory. BG was measured every 1-2 hours during continuous insulin infusion (CII) in the ICU, and before meals and at bedtime after transition to regular wards. The number of participants needing CII while in the ICU postoperatively was compared between patients randomized to dulaglutide or placebo study arms. | This analysis includes participants who completed the study. | Posted | Count of Participants | Participants | During the ICU stay (up to 7 days postoperatively) |
|
|
|
| Secondary | Number of Participants With Stress-hyperglycemia Requiring Rescue Therapy With Subcutaneous Insulin After Discontinuation of CII | Patients with two consecutive BG >180 mg/dl, or an average daily BG >180 mg/dl were started on rescue therapy with subcutaneous basal insulin (glargine or levemir) once daily. Information on BG measurements was collected both at bedside by glucose meter and by hospital laboratory. BG was measured every 1-2 hours during continuous insulin infusion (CII) in the ICU, and before meals and at bedtime after transition to regular wards. The number of participants in need of rescue therapy with subcutaneous insulin postoperatively, after CII was discontinued, was compared between study arms. | This analysis includes participants who required CII while in the ICU. | Posted | Count of Participants | Participants | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Mean Blood Glucose Levels During the Hospital Stay | To measure glucose control, the mean blood glucose levels in mg/dL during the non-ICU hospital stay postoperatively were measured. Information on BG measurements was collected both at bedside by glucose meter and by hospital laboratory. BG was measured every 1-2 hours during continuous insulin infusion (CII) in the ICU, and before meals and at bedtime after transition to regular wards. | This analysis includes participants who completed the study. | Posted | Mean | Standard Deviation | mg/dL | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Mean Units Per Hour of Insulin While in the ICU | The mean insulin dose during the time that participants were in the ICU is assessed as insulin infusion units per hour. | This analysis includes participants who required CII while in the ICU. | Posted | Mean | Standard Deviation | insulin units/hour | During the ICU stay (up to 7 days postoperatively) |
|
|
|
| Secondary | Mean Insulin Dose Per Day While in the ICU | The mean insulin dose during the time that participants were in the ICU is assessed as insulin units per day. | This analysis includes participants who required CII while in the ICU. | Posted | Mean | Standard Deviation | insulin units/day | During the ICU stay (up to 7 days postoperatively) |
|
|
|
| Secondary | Duration of Continuous Insulin Infusion (CII) | The duration of continuous insulin infusion (CII) is assessed in hours. | This analysis includes participants who required CII while in the ICU. | Posted | Mean | Standard Deviation | hours | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Days of Subcutaneous (SC) Insulin After Discontinuation of CII | Subcutaneous (SC) insulin use after continuous insulin infusion (CII) is discontinued is assessed as the number of days that SC insulin was required. | This analysis includes participants who required CII while in the ICU and subsequent SC after discontinuation of CII. | Posted | Mean | Standard Deviation | days | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Amount of SC Insulin Administered | The amount of subcutaneous (SC) insulin administered during the ICU and non-ICU hospital stay, among participants requiring SC insulin after discontinuing CII. | This analysis includes participants who required CII while in the ICU and subsequent SC after discontinuation of CII. | Posted | Mean | Standard Deviation | units of insulin | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Number of Participants Experiencing Hyperglycemic Events | Hyperglycemic events are defined as BG > 200 mg/dl, during ICU and non-ICU hospital stay. | This analysis includes participants who completed the study. | Posted | Count of Participants | Participants | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Number of Participants Experiencing Hypoglycemic Events | Hypoglycemic events are defined as BG <70, < 54, and <40 mg/dl occurring during ICU and non-ICU hospital stay. | This analysis includes participants who completed the study. | Posted | Count of Participants | Participants | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Number of Participants Experiencing Mortality and Complications | The number of participants experiencing a composite of mortality and complications. Complications include sternal wound infection, bacteremia, pneumonia, acute kidney injury, and acute myocardial infarction. | This analysis includes participants who completed the study. | Posted | Count of Participants | Participants | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Number of Participants Experiencing Gastrointestinal Adverse Events | The number participants who experienced gastrointestinal adverse events of nausea, vomiting, ileus, pancreatitis. | This analysis includes participants who completed the study. | Posted | Count of Participants | Participants | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | ICU Length of Stay | ICU length of stay is assessed as the mean number of days participants in each study arm spent in the ICU. | This analysis includes participants who completed the study. | Posted | Mean | Standard Deviation | days | During the ICU stay (up to 7 days postoperatively) |
|
|
|
| Secondary | Hospital Length of Stay | Hospital length of stay is assessed as the mean number of days participants in each study arm spent in the hospital. | This analysis includes participants who completed the study. | Posted | Mean | Standard Deviation | days | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Number of ICU Readmissions | The number of readmissions to the ICU. | This analysis includes participants who completed the study. | Posted | Number | ICU readmissions | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Number of Cerebrovascular Events | The number of cerebrovascular events. | This analysis includes participants who completed the study. | Posted | Number | cerebrovascular events | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| Secondary | Participant Mortality | The number of participant deaths while in the ICU and hospital. | This analysis includes participants who completed the study. | Posted | Count of Participants | Participants | During the hospital stay (up to 12 days postoperatively) |
|
|
|
| 0 |
| 12 |
| 1 |
| 12 |
| 4 |
| 12 |
| EG001 | Placebo | Participants without a history of DM who were randomized to receive a single injection of a placebo (saline injection of 0.5 mL pre-drawn solution) one to three days prior to surgery. | 0 | 13 | 0 | 13 | 2 | 13 |
| Acute kidney injury | Renal and urinary disorders | Systematic Assessment |
|
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| D001835 |
| Body Weight |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |
| D017670 |
| Sodium Compounds |
| BG <40 mg/dL |
|