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Table 1: Comparison of novel antidiabetic agents in the context of cardiac surgery. |
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Pharmacological Group |
Main Benefits |
Risks / Limitations |
Evidence in Cardiac Surgery |
Current Recommendation |
|
GLP-1 Agonists (liraglutide, exenatide) |
- Improved perioperative glycemic control - Reduced insulin requirements - Possible preservation of left ventricular function |
- Modest effects on hemodynamic function - Small sample sizes in studies - Heterogeneous results |
Small trials and some RCTs show improvements in glycemia and echocardiographic parameters |
Promising and safe, but larger studies are needed |
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DPP-4 Inhibitors (sitagliptin, saxagliptin, alogliptin) |
- Lower risk of hypoglycemia - Possible reduction in insulin doses |
- Inconsistent evidence in glycemic control - Risk of heart failure with saxagliptin/alogliptin - Potential for organ dysfunction |
Trials show conflicting results; some do not demonstrate significant differences in glycemia |
Not routinely recommended in cardiac surgery |
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SGLT2 Inhibitors (empagliflozin, dapagliflozin, sotagliflozin) |
- Cardioprotective and nephroprotective effects - Lower incidence of acute kidney injury (AKI) - Reduced perioperative inflammation - Lower cardiovascular mortality and revascularization rates |
- Risk of ketoacidosis (low but present) - Evidence still limited in cardiac surgery - Several studies with small sample sizes |
Pilot trials and retrospective studies show reduced AKI and improved long-term outcomes |
Highly promising, with the highest level of current evidence; larger RCTs required |
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AKI = acute kidney injury. RCT = randomized controlled trial. |
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