The effect of insulin administration on c-peptide in critically ill patients with type 2 diabetes
| Autor: | Rinaldo Bellomo, Glenn M Eastwood, Luca Lucchetta, Nora Luethi, Marco Crisman, Johan Mårtensson, Luca Cioccari, Que Lam |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2017 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment 030209 endocrinology & metabolism Type 2 diabetes Critical Care and Intensive Care Medicine 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Diabetes mellitus Critical care beta-cell Internal medicine Anesthesiology medicine Blood glucose Insulin Secretion Permissive C-peptide Critically ill business.industry Research lcsh:Medical emergencies. Critical care. Intensive care. First aid 030208 emergency & critical care medicine lcsh:RC86-88.9 medicine.disease Endocrinology chemistry business |
| Zdroj: | Annals of Intensive Care, Vol 7, Iss 1, Pp 1-8 (2017) Annals of Intensive Care |
| ISSN: | 2110-5820 |
| Popis: | Background In critically ill patients with permissive hyperglycemia, it is uncertain whether exogenous insulin administration suppresses or enhances c-peptide secretion (a marker of pancreatic beta-cell response). We aimed to explore this effect in patients with type 2 diabetes. Methods We prospectively enrolled a cohort of 45 critically ill patients with type 2 diabetes managed according to a liberal glucose protocol (target blood glucose 10–14 mmol/l). We recorded the administration of insulin and oral hypoglycemic agents and measured plasma c-peptide as surrogate marker of endogenous insulin secretion on the first two consecutive days in ICU. Results Overall, 20 (44.4%) patients required insulin to achieve target blood glucose. Insulin-treated patients had higher glycated hemoglobin A1c, more premorbid insulin-requiring type 2 diabetes, and greater blood glucose levels but lower c-peptide levels on admission. Premorbid insulin-requiring diabetes was independently associated with lower admission c-peptide, whereas greater plasma creatinine was independently associated with higher levels. Increases in c-peptide were positively correlated with an increase in blood glucose both in patients who did (r = 0.54, P = 0.01) and did not (r = 0.56, P = 0.004) receive insulin. However, insulin administration was independently associated with a greater increase in c-peptide (P = 0.04). This association was not modified by the use of oral insulin secretagogues. Conclusions C-peptide, a marker of beta-cell response, responds to and is influenced by glycemia and renal function in critically ill patients with type 2 diabetes. In addition, in our cohort, exogenous insulin administration was associated with a greater increase in c-peptide in response to hyperglycemia. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN12615000216516). Electronic supplementary material The online version of this article (doi:10.1186/s13613-017-0274-5) contains supplementary material, which is available to authorized users. |
| Databáze: | OpenAIRE |
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