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The glucoregulatory benefits of glucagon-like peptide-1 (7-36) amide infusion during intensive insulin therapy in critically ill surgical patients: a pilot study.
Crit Care Med. 2014 Mar; 42(3):638-45.CC

Abstract

OBJECTIVES

Intensive insulin therapy for tight glycemic control in critically ill surgical patients has been shown to reduce mortality; however, intensive insulin therapy is associated with iatrogenic hypoglycemia and increased variability of blood glucose levels. The incretin glucagon-like peptide-1 (7-36) amide is both insulinotropic and insulinomimetic and has been suggested as an adjunct to improve glycemic control in critically ill patients. We hypothesized that the addition of continuous infusion of glucagon-like peptide-1 to intensive insulin therapy would result in better glucose control, reduced requirement of exogenous insulin administration, and fewer hypoglycemic events.

DESIGN

Prospective, randomized, double-blind, placebo-controlled clinical trial.

SETTING

Surgical or burn ICU.

PATIENTS

Eighteen patients who required intensive insulin therapy.

INTERVENTIONS

A 72-hour continuous infusion of either glucagon-like peptide-1 (1.5 pmol/kg/min) or normal saline plus intensive insulin therapy.

MEASUREMENTS AND MAIN RESULTS

The glucagon-like peptide-1 cohort (n = 9) and saline cohort (n = 9) were similar in age, Acute Physiology and Chronic Health Evaluation score, and history of diabetes. Blood glucose levels in the glucagon-like peptide-1 group were better controlled with much less variability. The coefficient of variation of blood glucose ranged from 7.2% to 30.4% in the glucagon-like peptide-1 group and from 19.8% to 56.8% in saline group. The mean blood glucose coefficient of variation for the glucagon-like peptide-1 and saline groups was 18.0% ± 2.7% and 30.3% ± 4.0% (p = 0.010), respectively. The 72-hour average insulin infusion rates were 3.37 ± 0.61 and 4.57 ± 1.18 U/hr (p = not significant). The incidents of hypoglycemia (≤ 2.78 mmol/L) in both groups were low (one in the glucagon-like peptide-1 group, three in the saline group).

CONCLUSIONS

Glucagon-like peptide-1 (7-36) amide is a safe and efficacious form of adjunct therapy in patients with hyperglycemia in the surgical ICU setting. Improved stability of blood glucose is a favorable outcome, which enhances the safety of intensive insulin therapy. Larger studies of this potentially valuable therapy for glycemic control in the ICU are justified.

Authors+Show Affiliations

1Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD. 2Department of Surgery, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, MD. 3Clinical Physiology Branch, National Institute on Aging, Baltimore, MD. 4Department of Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

24247476

Citation

Galiatsatos, Panagis, et al. "The Glucoregulatory Benefits of Glucagon-like Peptide-1 (7-36) Amide Infusion During Intensive Insulin Therapy in Critically Ill Surgical Patients: a Pilot Study." Critical Care Medicine, vol. 42, no. 3, 2014, pp. 638-45.
Galiatsatos P, Gibson BR, Rabiee A, et al. The glucoregulatory benefits of glucagon-like peptide-1 (7-36) amide infusion during intensive insulin therapy in critically ill surgical patients: a pilot study. Crit Care Med. 2014;42(3):638-45.
Galiatsatos, P., Gibson, B. R., Rabiee, A., Carlson, O., Egan, J. M., Shannon, R. P., Andersen, D. K., & Elahi, D. (2014). The glucoregulatory benefits of glucagon-like peptide-1 (7-36) amide infusion during intensive insulin therapy in critically ill surgical patients: a pilot study. Critical Care Medicine, 42(3), 638-45. https://doi.org/10.1097/CCM.0000000000000035
Galiatsatos P, et al. The Glucoregulatory Benefits of Glucagon-like Peptide-1 (7-36) Amide Infusion During Intensive Insulin Therapy in Critically Ill Surgical Patients: a Pilot Study. Crit Care Med. 2014;42(3):638-45. PubMed PMID: 24247476.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The glucoregulatory benefits of glucagon-like peptide-1 (7-36) amide infusion during intensive insulin therapy in critically ill surgical patients: a pilot study. AU - Galiatsatos,Panagis, AU - Gibson,B Robert, AU - Rabiee,Atoosa, AU - Carlson,Olga, AU - Egan,Josephine M, AU - Shannon,Richard P, AU - Andersen,Dana K, AU - Elahi,Dariush, PY - 2013/11/20/entrez PY - 2013/11/20/pubmed PY - 2014/4/23/medline SP - 638 EP - 45 JF - Critical care medicine JO - Crit Care Med VL - 42 IS - 3 N2 - OBJECTIVES: Intensive insulin therapy for tight glycemic control in critically ill surgical patients has been shown to reduce mortality; however, intensive insulin therapy is associated with iatrogenic hypoglycemia and increased variability of blood glucose levels. The incretin glucagon-like peptide-1 (7-36) amide is both insulinotropic and insulinomimetic and has been suggested as an adjunct to improve glycemic control in critically ill patients. We hypothesized that the addition of continuous infusion of glucagon-like peptide-1 to intensive insulin therapy would result in better glucose control, reduced requirement of exogenous insulin administration, and fewer hypoglycemic events. DESIGN: Prospective, randomized, double-blind, placebo-controlled clinical trial. SETTING: Surgical or burn ICU. PATIENTS: Eighteen patients who required intensive insulin therapy. INTERVENTIONS: A 72-hour continuous infusion of either glucagon-like peptide-1 (1.5 pmol/kg/min) or normal saline plus intensive insulin therapy. MEASUREMENTS AND MAIN RESULTS: The glucagon-like peptide-1 cohort (n = 9) and saline cohort (n = 9) were similar in age, Acute Physiology and Chronic Health Evaluation score, and history of diabetes. Blood glucose levels in the glucagon-like peptide-1 group were better controlled with much less variability. The coefficient of variation of blood glucose ranged from 7.2% to 30.4% in the glucagon-like peptide-1 group and from 19.8% to 56.8% in saline group. The mean blood glucose coefficient of variation for the glucagon-like peptide-1 and saline groups was 18.0% ± 2.7% and 30.3% ± 4.0% (p = 0.010), respectively. The 72-hour average insulin infusion rates were 3.37 ± 0.61 and 4.57 ± 1.18 U/hr (p = not significant). The incidents of hypoglycemia (≤ 2.78 mmol/L) in both groups were low (one in the glucagon-like peptide-1 group, three in the saline group). CONCLUSIONS: Glucagon-like peptide-1 (7-36) amide is a safe and efficacious form of adjunct therapy in patients with hyperglycemia in the surgical ICU setting. Improved stability of blood glucose is a favorable outcome, which enhances the safety of intensive insulin therapy. Larger studies of this potentially valuable therapy for glycemic control in the ICU are justified. SN - 1530-0293 UR - https://www.unboundmedicine.com/medline/citation/24247476/The_glucoregulatory_benefits_of_glucagon_like_peptide_1__7_36__amide_infusion_during_intensive_insulin_therapy_in_critically_ill_surgical_patients:_a_pilot_study_ L2 - https://dx.doi.org/10.1097/CCM.0000000000000035 DB - PRIME DP - Unbound Medicine ER -