GLP-1 Receptor Agonists in Hospitalized Patients

Evidence for Inpatient Use

The American Association of Clinical Endocrinologists recommends using GLP-1 receptor agonists with caution in patients with a history of pancreatitis 1, 2
Liraglutide demonstrates insulin-sparing effects in cardiac surgery patients, with 43% of liraglutide-treated patients requiring intraoperative insulin versus 61% in the placebo group (p=0.003) 1, 2
Liraglutide improved postoperative left ventricular systolic function, with 68% achieving normal function versus 53% in the placebo group (p=0.049) 1
Intravenous GLP-1 and exenatide infusions in coronary artery bypass grafting showed significant insulin-sparing effects with plasma glucose reductions 1, 2
Exenatide plus basal insulin resulted in 78% of glucose readings within the target range (3.9-10.0 mmol/L) compared to 62% with exenatide alone or 63% with basal-bolus insulin 3
GLP-1 receptor agonists are effective for patients with mild-to-moderate hyperglycemia (<10 mmol/L or 180 mg/dL) 3

Emerging evidence shows an increased pulmonary aspiration risk under anesthesia despite prolonged fasting 4, 1
Nausea, vomiting, and diarrhea are dose-dependent and more frequent with short-acting than long-acting formulations 1, 2
Slow titration increases gastrointestinal tolerability 1, 2
Increased gastrointestinal side effects may counterbalance glycemic benefits in the hospital setting 3

Non-ICU patients with type 2 diabetes and mild-to-moderate hyperglycemia (<10 mmol/L) are appropriate candidates for GLP-1 agonists 3
Perioperative cardiac surgery patients requiring glycemic control are appropriate candidates for GLP-1 agonists 1, 2
Patients already on GLP-1 therapy admitted for medical conditions without contraindications can continue GLP-1 agonists 5, 6

Start at low doses and titrate slowly to minimize gastrointestinal side effects 1, 2
Monitor glucose levels to assess efficacy versus insulin alternatives 1, 3
Assess bowel movement frequency and consistency at follow-up visits 7
Monitor for signs of bowel obstruction 7
Watch for cardiac arrhythmia/tachycardia; consider beta blockers if symptomatic 2

Non-ICU patients with type 2 diabetes and mild-to-moderate hyperglycemia can receive GLP-1 receptor agonists, particularly when combined with basal insulin, as recommended by the American College of Endocrinology 8
Perioperative cardiac surgery patients may benefit from preoperative liraglutide treatment, which improves glycemic control and demonstrates insulin-sparing effects, according to the American Heart Association 8
Exenatide plus basal insulin achieved 78% of glucose readings within target range compared to 62% with exenatide alone or 63% with basal-bolus insulin in non-ICU patients, as reported by the Endocrine Society 8

Recent heart failure decompensation is a contraindication for GLP-1 receptor agonists, as recommended by the American Heart Association, due to increased HF readmission risk 9, 10
Severe hyperglycemia (>16.6 mmol/L or >300 mg/dL) requires basal-bolus insulin regimens, according to the American Diabetes Association 11
Type 1 diabetes requires insulin as the agent of choice, as stated by the American Diabetes Association 11
Critical illness or ICU patients require continuous insulin infusion as the therapy of choice, as recommended by the Society of Critical Care Medicine 11

Combining GLP-1 receptor agonists with basal insulin is recommended for optimal glycemic control in patients with moderate hyperglycemia, according to the American Association of Clinical Endocrinologists 8, 11
Correction doses with rapid-acting insulin may be considered before meals or every 6 hours as needed, as suggested by the American Diabetes Association 11