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Introduction: Insulin resistance is characterized by reduced response of target cells to exposed insulin concentration. It is part of type 2 diabetes, metabolic syndrome, obesity and underlying cause of cardiovascular and neurodegenerative diseases. Hyperglycemia commonly occures in the course of any critical illness. It appeares both among patient with or without apparent glucose metabolism disorder. We hypothesised that the cause of hyperglycemia in critical illness among patients without apparent glucose metabolism disorder lies in intrinsically increased insulin resistance of those patients. Patients and methods: Patients admitted to the intensive care unit of the University Hospital Centre Zagreb due to critical illness were included in the research. Patients with no history of impaired glucose metabolism were divided into hyperglycemia group (glucose >7.7 mmol/l, measured on at least two occasions) and normoglycemia group. Glycated haemoglobin during hospital stay and oral glucose tolerance test within 6-8 weeks after discharge were all performed in order to disclose patients with unknown diabetes or pre-diabetes who were excluded from the research. On the ambulatory appointment 6-8 weeks after discharge insulin resistance is assessed by indirect methods. Insulin resistance was measured with simple indices: QUICKI, HOMA-IR, log HOMA-IR HOMA2-IR Results: Research was concluded on 221 patients, 114 were in hyperglycemia group while 107 were part of normoglycemia group. There were no signifficant differences in age nor sex among groups. BMI, WHR and positive family history of DM type II showed higher values in hyperglycemia group. Patients in hyperglycemia group had signifficant higher values of insulin resistance measured with all simple insulin resistance indices compared with patients in normoglycemia group. Multivariate logistic regression analysis showed independent association of BMI, WHR, HOMA-IR and QUICKI with occurrence of hyperglycemia in acute illness. Conslusion: Occurrence of hyperglycemia in critical illness among patients without apparent glucose metabolism disorder is associated with intrinsically increased insulin resistance. |
