Glucose Metabolism in Critically Ill Patients: Are Incretins an Important Player?

Critical illness afflicts millions of people worldwide and is associated with a high risk of organ failure and death or an adverse outcome with persistent physical or cognitive deficits. Spontaneous hyperglycemia is common in critically ill patients and is associated with an adverse outcome compared...

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Bibliographic Details
Published in:Journal of intensive care medicine 2015-05, Vol.30 (4), p.201-208
Main Authors: Nielsen, Signe Tellerup, Krogh-Madsen, Rikke, Møller, Kirsten
Format: Article
Language:English
Subjects:
Blood Glucose - drug effects
Blood Glucose - metabolism
Critical Illness - therapy
Glucagon-Like Peptide 1 - therapeutic use
Humans
Hyperglycemia - drug therapy
Hypoglycemia - drug therapy
Hypoglycemia - etiology
Hypoglycemic Agents - therapeutic use
Incretins - therapeutic use
Insulin - metabolism
Insulin - therapeutic use
Insulin Secretion
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Summary:Critical illness afflicts millions of people worldwide and is associated with a high risk of organ failure and death or an adverse outcome with persistent physical or cognitive deficits. Spontaneous hyperglycemia is common in critically ill patients and is associated with an adverse outcome compared to normoglycemia. Insulin is used for treating hyperglycemia in the critically ill patients but may be complicated by hypoglycemia, which is difficult to detect in these patients and which may lead to serious neurological sequelae and death. The incretin hormone, glucagon-like peptide (GLP) 1, stimulates insulin secretion and inhibits glucagon release both in healthy individuals and in patients with type 2 diabetes (T2DM). Compared to insulin, GLP-1 appears to be associated with a lower risk of severe hypoglycemia, probably because the magnitude of its insulinotropic action is dependent on blood glucose (BG). This is taken advantage of in the treatment of patients with T2DM, for whom GLP-1 analogs have been introduced during the recent years. Infusion of GLP-1 also lowers the BG level in critically ill patients without causing severe hypoglycemia. The T2DM and critical illness share similar characteristics and are, among other things, both characterized by different grades of systemic inflammation and insulin resistance. The GLP-1 might be a potential new treatment target in critically ill patients with stress-induced hyperglycemia.
ISSN:0885-0666
1525-1489
DOI:10.1177/0885066613503291