GLP-1 Receptor Agonists and Insulin Versus Insulin for Perioperative Glycemic Control in Patients with Type 2 Diabetes Undergoing Cardiac Surgery: A Systematic Review
8 affiliations
- 1Department of Medicine, Dow University of Health Sciences, Dow Medical College, Karachi, Pakistan
- 2Department of Medicine, An-Najah National University, Nablus, Palestine
- 3Faculty of Medicine, Damascus University, Damascus, Syria
- 4KFS University, Faculty of Medicine and Rehabilitation / Intern Student, Egypt
- 5Faculty of Medicine, Hebron University, Hebron, Palestine
- 6Department of Medicine, Al-Tibri Medical College, Isra University, Karachi, Pakistan
- 7Department of Nursing, Hamad Medical Corporation, Doha, Qatar
- 8Department of Internal Medicine, Chitwan Medical College, Bharatpur, Nepal
Abstract
Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing cardiac surgery and is linked to adverse outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer glucose-dependent insulinotropic effects and potential cardiac benefits, but their perioperative role remains uncertain. This review evaluated the efficacy and safety of GLP-1 RA therapy as an adjunct to insulin in this setting. Three electronic databases (PubMed, Cochrane, and Google Scholar) were searched for relevant articles up to October 2025. The primary endpoint was blood glucose levels during the perioperative period, while secondary endpoints included hypoglycemia incidence, total insulin requirement, time in target glucose range, and postoperative complications. Three randomized controlled trials (RCTs) including 168 patients with type 2 diabetes undergoing cardiac surgery were assessed. Perioperative use of liraglutide (subcutaneously in doses of 0.6-1.8 mg/day) was associated with preliminary evidence of improved glycemic control across preoperative, intraoperative, and early postoperative periods, including lower glucose levels, reduced glycemic variability, and fewer insulin adjustments, with a low incidence of hypoglycemia. However, heterogeneity in dosing, timing, and monitoring protocols across studies limits direct comparisons. Mild gastrointestinal adverse events, such as nausea and vomiting, were more frequent with liraglutide. One study reported exploratory immunometabolic effects in adipose tissue. Preliminary evidence from these heterogeneous studies suggests that adding liraglutide to insulin may improve perioperative glycemic control compared to insulin or placebo in patients with type 2 diabetes undergoing cardiac surgery. However, findings are limited by the small number of studies, methodological variability, and lack of long-term outcomes, necessitating larger, standardized trials.
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BibTeX
@article{hassan2026glp1,
title = {{GLP-1 Receptor Agonists and Insulin Versus Insulin for Perioperative Glycemic Control in Patients with Type 2 Diabetes Undergoing Cardiac Surgery: A Systematic Review}},
author = {Danish Hassan and Rida Shakeel and Waleed Qaisi and Syed Rayyan Ahmed and Javeria Taj and Mohammad Adi and Ahmed Yousry Ahmed and Ammir Abuzahra and Emad Uddin Sajid and Hamza Arshad Khan and Tuba Basit and Javed Iqbal and Asraf Hussain},
journal = {Annals of Cardiac Anaesthesia},
year = {2026},
month = oct,
doi = {10.4103/aca.aca_307_25},
url = {https://doi.org/10.4103/aca.aca_307_25},
note = {CC BY-NC-SA 4.0},
}
RIS
TY - JOUR
TI - GLP-1 Receptor Agonists and Insulin Versus Insulin for Perioperative Glycemic Control in Patients with Type 2 Diabetes Undergoing Cardiac Surgery: A Systematic Review
AU - Danish Hassan
AU - Rida Shakeel
AU - Waleed Qaisi
AU - Syed Rayyan Ahmed
AU - Javeria Taj
AU - Mohammad Adi
AU - Ahmed Yousry Ahmed
AU - Ammir Abuzahra
AU - Emad Uddin Sajid
AU - Hamza Arshad Khan
AU - Tuba Basit
AU - Javed Iqbal
AU - Asraf Hussain
PY - 2026
DA - 2026/10/12
JO - Annals of Cardiac Anaesthesia
DO - 10.4103/aca.aca_307_25
UR - https://doi.org/10.4103/aca.aca_307_25
AB - Perioperative hyperglycemia is common in patients with type 2 diabetes undergoing cardiac surgery and is linked to adverse outcomes. Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) offer glucose-dependent insulinotropic effects and potential cardiac benefits, but their perioperative role remains uncertain. This review evaluated the efficacy and safety of GLP-1 RA therapy as an adjunct to insulin in this setting. Three electronic databases (PubMed, Cochrane, and Google Scholar) were searched for relevant articles up to October 2025. The primary endpoint was blood glucose levels during the perioperative period, while secondary endpoints included hypoglycemia incidence, total insulin requirement, time in target glucose range, and postoperative complications. Three randomized controlled trials (RCTs) including 168 patients with type 2 diabetes undergoing cardiac surgery were assessed. Perioperative use of liraglutide (subcutaneously in doses of 0.6-1.8 mg/day) was associated with preliminary evidence of improved glycemic control across preoperative, intraoperative, and early postoperative periods, including lower glucose levels, reduced glycemic variability, and fewer insulin adjustments, with a low incidence of hypoglycemia. However, heterogeneity in dosing, timing, and monitoring protocols across studies limits direct comparisons. Mild gastrointestinal adverse events, such as nausea and vomiting, were more frequent with liraglutide. One study reported exploratory immunometabolic effects in adipose tissue. Preliminary evidence from these heterogeneous studies suggests that adding liraglutide to insulin may improve perioperative glycemic control compared to insulin or placebo in patients with type 2 diabetes undergoing cardiac surgery. However, findings are limited by the small number of studies, methodological variability, and lack of long-term outcomes, necessitating larger, standardized trials.
SN - 0971-9784
SN - 0974-5181
ER -