Endocrine Abstracts

Introduction: Diabetic patients with limited exercise during orthopedic perioperative period tend to gain weight, and their glycemic control frequently deteriorates. However, temporary insulin therapy has a risk of hypoglycemia. To investigate the efficacy and safety of perioperative liraglutide therapy, we performed a retrospective case analysis.

Research design and methods: Twenty one Japanese patients with T2DM (male/female; 9/12, Age; 68.2±14.7 years, HbA1c; 8.0±1.2%, BMI; 26.3±2.7) were initially treated with 0.3 mg of liraglutide and allowed to dose-titrate up to 0.9 mg/day before elective orthopedic operations, e.g. spine surgeries (9 cases), artificial knee joint replacement (9), bone fracture surgeries (2), and amputation surgery of toe necrosis (1). In case of hyperglycemia (blood glucose level is over 200 mg/dl) during operation, regular insulin was added. Change in body weight, fluctuation of glycemic level, and perioperative complications were analysed.

Results: After initiation of liragludite therapy, the body weight decreased in 3.3±2.0 kg before operation. Liraglutide therapy achieved good glycemic control throughout the perioperative period. One patient suffering painful knee osteoarthritis lost weight with preoperative liraglutide therapy, and eventually he avoided the knee operation because his knee pain disappeared. Two patients could not increase dose-titrate up to 0.9 mg because of nausea as a side effect. Additional regular insulin was not needed except for 5 patients who were prescribed only 4 unit of insulin during operation. Twenty out of 21 patients withdrew liraglutide therapy after operation and rehabilitation. Hypoglycemic episodes, retardation of wound healing, or other complications were not observed.

Conclusion: Liraglutide provides an effective and optional way to safely achieve good glycemic control in perioperative for orthopedic operations subjects with T2DM, especially those with limited exercise ability and those at risk of hypoglycemia.