The glucoregulatory benefits of glucagon-like Peptide-1 (7-36) amide infusion during intensive insulin therapy in critically Ill Surgical Patients

A pilot study

Panagis Galiatsatos, B. Robert Gibson, Atoosa Rabiee, Olga Carlson, Josephine M. Egan, Richard P. Shannon, Dana Andersen, Dariush Elahi

Research output: Contribution to journalArticle

22 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)638-645
Number of pages8
JournalCritical Care Medicine
Volume42
Issue number3
DOIs
StatePublished - Mar 2014
Externally publishedYes

Fingerprint

Glucagon-Like Peptide 1
Critical Illness
Insulin
Blood Glucose
Therapeutics
Hypoglycemia
Incretins
APACHE
glucagon-like peptide 1 (7-36)amide
Controlled Clinical Trials
Hypoglycemic Agents
Hyperglycemia
Placebos
Safety
Glucose
Mortality

Keywords

  • GLP-1 (7-36) amide
  • hypoglycemia
  • intensive insulin therapy
  • surgical intensive care unit

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

Cite this

The glucoregulatory benefits of glucagon-like Peptide-1 (7-36) amide infusion during intensive insulin therapy in critically Ill Surgical Patients : A pilot study. / Galiatsatos, Panagis; Gibson, B. Robert; Rabiee, Atoosa; Carlson, Olga; Egan, Josephine M.; Shannon, Richard P.; Andersen, Dana; Elahi, Dariush.

In: Critical Care Medicine, Vol. 42, No. 3, 03.2014, p. 638-645.

Research output: Contribution to journalArticle

Galiatsatos, Panagis ; Gibson, B. Robert ; Rabiee, Atoosa ; Carlson, Olga ; Egan, Josephine M. ; Shannon, Richard P. ; Andersen, Dana ; Elahi, Dariush. / The glucoregulatory benefits of glucagon-like Peptide-1 (7-36) amide infusion during intensive insulin therapy in critically Ill Surgical Patients : A pilot study. In: Critical Care Medicine. 2014 ; Vol. 42, No. 3. pp. 638-645.
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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.",
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T2 - 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

AU - Elahi, Dariush

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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.

AB - 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.

KW - GLP-1 (7-36) amide

KW - hypoglycemia

KW - intensive insulin therapy

KW - surgical intensive care unit

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