Intravenous Exenatide in Coronary Intensive Care Unit (ICU) Patients

Diabetic patients with acute myocardial infarction (MI) have particularly poor outcomes.
Clinical practice guidelines from the American College of Cardiology/American Heart
Association for the treatment of patients with acute coronary syndromes call for treatment
to achieve preprandial glucose <110 mg/dL, a maximum daily target <180 mg/dL, and a
post-discharge hemoglobin A1c <7%. Initiation of aggressive insulin therapy is also
warranted to achieve blood glucose <150 mg/dL during days 0-3 and 80-110 mg/dL when possible
thereafter. To date, no studies have been conducted assessing the efficacy of intravenous
exenatide administration on achieving glucose lowering in hyperglycemic coronary ICU
patients.

Inclusion Criteria:

- Admission to coronary ICU

- Admission blood glucose 140-299 mg/dL

- Primary cardiovascular diagnosis by attending physician

- Under primary care of cardiology service

- Age > 18 years old

- Ventilator independent

- Able to provide informed consent

Exclusion Criteria:

- Admission blood glucose < 140 or > 300 mg/dL

- Ventilator dependent

- Unconscious sedation

- Type 1 diabetes

- Known pregnancy

- Admitted to CICU for right heart cath to measure hemodynamics prior to transplant

- Post transplant procedure

- Currently enrolled in another clinical trial

- Unable to provide informed consent

- Creatinine clearance < 30 mL/min

- On insulin treatment except for monotherapy with long-acting basal insulin (e.g.,
insulin glargine [Lantus®] or detemir [Levemir®])

- Gastroparesis