High dose amino acid administration achieves an anabolic response in type 2 diabetic patients that is independent of glycaemic control: A randomized clinical trial
| Autor: | Harald Schepperle, Thomas Peters, Patricia Roque, Linda Wykes, Andrea Kopp Lugli, Albert Urwyler, Chelsia Gillis, Thomas Schricker, Guido Kunz, Jürgen Bläss |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Blood Glucose
Male medicine.medical_specialty Surgical stress medicine.medical_treatment Protein metabolism 030209 endocrinology & metabolism Type 2 diabetes Carbohydrate metabolism Critical Care and Intensive Care Medicine Perioperative Care 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Internal medicine Humans Insulin Medicine 030212 general & internal medicine Amino Acids Digestive System Surgical Procedures Aged Aged 80 and over Nutrition and Dietetics Nutritional Support business.industry Type 2 Diabetes Mellitus Perioperative Middle Aged medicine.disease Protein catabolism Endocrinology Diabetes Mellitus Type 2 chemistry Female Colorectal Neoplasms business |
| Zdroj: | Clinical Nutrition. 37:1163-1171 |
| ISSN: | 0261-5614 |
| DOI: | 10.1016/j.clnu.2017.04.016 |
| Popis: | Surgical stress provokes protein catabolism and hyperglycaemia that is enhanced in patients with type 2 diabetes (T2DM), and increases perioperative morbidity. This study hypothesized that perioperative administration of high dose intravenous (IV) amino acids (AA) will augment protein balance in T2DM patients receiving tight plasma glucose control via continuous IV insulin compared to standard plasma glucose control via subcutaneous (SC) insulin sliding scale.Eighteen patients with well-controlled T2DM (HbA1C% 7.1) undergoing colorectal surgery were assigned randomly to receive standard glucose control (6-10 mmol/l, SC insulin, n = 9) or tight glucose control (4-6 mmol/l, IV insulin, n = 9). Both groups received general anaesthesia and epidural analgesia. AA (1 ml/kg h Aminoven™ 10%, ∼2.4 g/kg d) were infused via a peripheral vein for two 3-h periods: at the beginning of surgery and in the post-operative care unit. Whole-body protein and glucose kinetics were assessed by stable isotope tracers, L-[1-Whole-body protein balance was positive after surgery in all patients. Since protein synthesis, breakdown and leucine oxidation were comparable in both groups, whole body protein balance was not different (p = 0.605). Tight glucose control suppressed endogenous glucose production (EGP, p 0.001) and increased glucose clearance (p 0.001) compared to standard glucose control during both study periods. No episode of hypoglycaemia occurred in either group.High-dose perioperative AA administration under optimal anti-catabolic care with epidural analgesia was effective in achieving a positive protein balance in T2DM patients undergoing surgery that was independent of glycaemic control strategy. Continuous IV insulin maintained normoglycaemia by inhibiting EGP and increasing glucose clearance. Improved glucose control, without a pronounced increase in protein balance with the intravenous insulin regimen, suggests perioperative protein metabolism may be less sensitive to insulin than is glucose. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect