The effect of exogenous glucagon-like peptide-1 on the glycaemic response to small intestinal nutrient in the critically ill: a randomised double-blind placebo-controlled cross over study

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dc.contributor.authorDeane, A.
dc.contributor.authorChapman, M.
dc.contributor.authorFraser, R.
dc.contributor.authorBurgstad, C.
dc.contributor.authorBesanko, L.
dc.contributor.authorHorowitz, M.
dc.date.issued2009
dc.description.abstract<h4>Introduction</h4>Hyperglycaemia occurs frequently in the critically ill, affects outcome adversely, and is exacerbated by enteral feeding. Furthermore, treatment with insulin in this group is frequently complicated by hypoglycaemia. In healthy patients and those with type 2 diabetes, exogenous glucagon-like peptide-1 (GLP-1) decreases blood glucose by suppressing glucagon, stimulating insulin and slowing gastric emptying. Because the former effects are glucose-dependent, the use of GLP-1 is not associated with hypoglycaemia. The objective of this study was to establish if exogenous GLP-1 attenuates the glycaemic response to enteral nutrition in patients with critical illness induced hyperglycaemia.<h4>Methods</h4>Seven mechanically ventilated critically ill patients, not previously known to have diabetes, received two intravenous infusions of GLP-1 (1.2 pmol/kg/min) and placebo (4% albumin) over 270 minutes. Infusions were administered on consecutive days in a randomised, double-blind fashion. On both days a mixed nutrient liquid was infused, via a post-pyloric feeding catheter, at a rate of 1.5 kcal/min between 30 and 270 minutes. Blood glucose and plasma GLP-1, insulin and glucagon concentrations were measured.<h4>Results</h4>In all patients, exogenous GLP-1 infusion reduced the overall glycaemic response during enteral nutrient stimulation (AUC30-270 min GLP-1 (2077 +/- 144 mmol/l min) vs placebo (2568 +/- 208 mmol/l min); P = 0.02) and the peak blood glucose (GLP-1 (10.1 +/- 0.7 mmol/l) vs placebo (12.7 +/- 1.0 mmol/l); P < 0.01). The insulin/glucose ratio at 270 minutes was increased with GLP-1 infusion (GLP-1 (9.1 +/- 2.7) vs. placebo (5.8 +/- 1.8); P = 0.02) but there was no difference in absolute insulin concentrations. There was a transient, non-sustained, reduction in plasma glucagon concentrations during GLP-1 infusion (t = 30 minutes GLP-1 (90 +/- 12 pmol/ml) vs. placebo (104 +/- 10 pmol/ml); P < 0.01).<h4>Conclusions</h4>Acute, exogenous GLP-1 infusion markedly attenuates the glycaemic response to enteral nutrition in the critically ill. These observations suggest that GLP-1 and/or its analogues have the potential to manage hyperglycaemia in the critically ill.<h4>Trial registration</h4>Australian New Zealand Clinical Trials Registry number: ACTRN12609000093280.
dc.description.statementofresponsibilityAdam M. Deane, Marianne J. Chapman, Robert J.L. Fraser, Carly M. Burgstad, Laura K. Besanko and Michael Horowitz
dc.identifier.citationCritical Care, 2009; 13(3):1-6
dc.identifier.doi10.1186/cc7874
dc.identifier.issn1466-609X
dc.identifier.issn1466-609X
dc.identifier.orcidDeane, A. [0000-0002-7620-5577]
dc.identifier.orcidChapman, M. [0000-0003-0710-3283]
dc.identifier.orcidHorowitz, M. [0000-0002-0942-0306]
dc.identifier.urihttp://hdl.handle.net/2440/51198
dc.language.isoen
dc.publisherCurrent Science Ltd
dc.rights© 2009 Deane et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The electronic version of this article is the complete one and can be found online at: http://ccforum.com/content/13/3/R67
dc.source.urihttps://doi.org/10.1186/cc7874
dc.subjectHumans
dc.subjectHyperglycemia
dc.subjectHypoglycemia
dc.subjectCritical Illness
dc.subjectGlucagon
dc.subjectInsulin
dc.subjectBlood Glucose
dc.subjectEnteral Nutrition
dc.subjectInfusions, Intravenous
dc.subjectArea Under Curve
dc.subjectCross-Over Studies
dc.subjectDouble-Blind Method
dc.subjectAdult
dc.subjectAged
dc.subjectMiddle Aged
dc.subjectFemale
dc.subjectMale
dc.subjectGlucagon-Like Peptide 1
dc.subjectIncretins
dc.titleThe effect of exogenous glucagon-like peptide-1 on the glycaemic response to small intestinal nutrient in the critically ill: a randomised double-blind placebo-controlled cross over study
dc.typeJournal article
pubs.publication-statusPublished

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