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Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients.
Crit Care Med. 2006 Feb; 34(2):381-6.CC

Abstract

BACKGROUND

Dipeptide alanyl-glutamine is a commonly used substrate in major trauma patients. Its importance and effects are widely discussed; as yet, it has not been elucidated whether its administration influences glucose homeostasis.

OBJECTIVE

We studied the effect of alanyl-glutamine administration on insulin resistance.

DESIGN

Prospective, randomized, controlled trial.

SETTING

Intensive care unit of a tertiary level hospital.

PATIENTS

Multiple-trauma patients.

INTERVENTIONS

Patients were randomized into two groups and assigned to receive parenterally an equal dose of amino acids either with alanyl-glutamine in the dose of 0.4 g x kg body weight(-1) x 24 hrs(-1) (group AG) or without alanyl-glutamine (control group C). This regimen started 24 hrs after injury and continued for 7 days. To assess insulin sensitivity, we performed an euglycemic clamp on day 4 and day 8 after injury.

MEASUREMENTS AND MAIN RESULTS

We randomized 40 patients, 20 into each group. At day 4, insulin-mediated glucose disposal was higher in group AG (2.4 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference from group C (1.9 +/- 0.6 mg x kg(-1) x min(-1), p = .044). At day 8, glucose disposal was higher in group AG (2.2 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference in comparison with group C (1.2 +/- 0.6, p < .001). Diminution of the main glucose homeostasis variables in group C between days 4 and 8 of the study was statistically significant (p < .001); however, differences in these variables in group AG were without statistical significance.

CONCLUSIONS

Parenteral supplementation of alanyl-glutamine dipeptide was associated with better insulin sensitivity in multiple-trauma patients.

Authors+Show Affiliations

Department of Anesthesiology and Intensive Care Medicine, Charles University Third Faculty of Medicine, Kralovske Vinohrady Hospital, Prague, the Czech Republic.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

16424718

Citation

Bakalar, Bohumil, et al. "Parenterally Administered Dipeptide Alanyl-glutamine Prevents Worsening of Insulin Sensitivity in Multiple-trauma Patients." Critical Care Medicine, vol. 34, no. 2, 2006, pp. 381-6.
Bakalar B, Duska F, Pachl J, et al. Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients. Crit Care Med. 2006;34(2):381-6.
Bakalar, B., Duska, F., Pachl, J., Fric, M., Otahal, M., Pazout, J., & Andel, M. (2006). Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients. Critical Care Medicine, 34(2), 381-6.
Bakalar B, et al. Parenterally Administered Dipeptide Alanyl-glutamine Prevents Worsening of Insulin Sensitivity in Multiple-trauma Patients. Crit Care Med. 2006;34(2):381-6. PubMed PMID: 16424718.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients. AU - Bakalar,Bohumil, AU - Duska,Frantisek, AU - Pachl,Jan, AU - Fric,Michal, AU - Otahal,Michal, AU - Pazout,Jaroslav, AU - Andel,Michal, PY - 2006/1/21/pubmed PY - 2006/2/8/medline PY - 2006/1/21/entrez SP - 381 EP - 6 JF - Critical care medicine JO - Crit Care Med VL - 34 IS - 2 N2 - BACKGROUND: Dipeptide alanyl-glutamine is a commonly used substrate in major trauma patients. Its importance and effects are widely discussed; as yet, it has not been elucidated whether its administration influences glucose homeostasis. OBJECTIVE: We studied the effect of alanyl-glutamine administration on insulin resistance. DESIGN: Prospective, randomized, controlled trial. SETTING: Intensive care unit of a tertiary level hospital. PATIENTS: Multiple-trauma patients. INTERVENTIONS: Patients were randomized into two groups and assigned to receive parenterally an equal dose of amino acids either with alanyl-glutamine in the dose of 0.4 g x kg body weight(-1) x 24 hrs(-1) (group AG) or without alanyl-glutamine (control group C). This regimen started 24 hrs after injury and continued for 7 days. To assess insulin sensitivity, we performed an euglycemic clamp on day 4 and day 8 after injury. MEASUREMENTS AND MAIN RESULTS: We randomized 40 patients, 20 into each group. At day 4, insulin-mediated glucose disposal was higher in group AG (2.4 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference from group C (1.9 +/- 0.6 mg x kg(-1) x min(-1), p = .044). At day 8, glucose disposal was higher in group AG (2.2 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference in comparison with group C (1.2 +/- 0.6, p < .001). Diminution of the main glucose homeostasis variables in group C between days 4 and 8 of the study was statistically significant (p < .001); however, differences in these variables in group AG were without statistical significance. CONCLUSIONS: Parenteral supplementation of alanyl-glutamine dipeptide was associated with better insulin sensitivity in multiple-trauma patients. SN - 0090-3493 UR - https://www.unboundmedicine.com/medline/citation/16424718/Parenterally_administered_dipeptide_alanyl_glutamine_prevents_worsening_of_insulin_sensitivity_in_multiple_trauma_patients_ L2 - https://dx.doi.org/10.1097/01.ccm.0000196829.30741.d4 DB - PRIME DP - Unbound Medicine ER -