Effects of glucose-dependent insulinotropic polypeptide on gastric emptying, glycaemia and insulinaemia during critical illness: a prospective, double blind, randomised, crossover study
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- 作者：Palash Kar (1)
Caroline E Cousins (1)
Christopher E Annink (1)
Karen L Jones (2) (3)
Marianne J Chapman (1) (4)
Juris J Meier (5)
Michael A Nauck (6)
Michael Horowitz (2) (3)
Adam M Deane (1) (4)
1. Intensive Care Unit ; Level 4 ; Emergency Services Building ; Royal Adelaide Hospital ; North Terrace ; Adelaide ; South Australia ; 5000 ; Australia
2. Discipline of Medicine ; The University of Adelaide ; Royal Adelaide Hospital ; Level 6 Eleanor Harrald Building ; North Terrace ; Adelaide ; South Australia ; 5000 ; Australia
3. Centre of Research Excellence in Translating Nutritional Science to Good Health ; The University of Adelaide ; Level 6 ; Eleanor Harrald Building ; North Terrace ; Adelaide ; South Australia ; 5000 ; Australia
4. Discipline of Acute Care Medicine ; The University of Adelaide ; North Terrace ; Adelaide ; South Australia ; 5000 ; Australia
5. Diabetes Division ; Department of Medicine I ; St. Josef-Hospital ; Ruhr-University Bochum ; Gudrunstra脽e 56 ; Bochum ; 44791 ; Germany
6. Diabetes Centre ; Bad Lauterberg ; Kirchberg 21 ; Bad Lauterberg ; Harz ; 37431 ; Germany - 刊名：Critical Care
- 出版年：2015
- 出版时间：December 2015
- 年：2015
- 卷：19
- 期：1
- 全文大小：898 KB
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- 出版者：BioMed Central
- ISSN：1364-8535
文摘
Introduction Insulin is used to treat hyperglycaemia in critically ill patients but can cause hypoglycaemia, which is associated with poorer outcomes. In health glucose-dependent insulinotropic polypeptide (GIP) is a potent glucose-lowering peptide that does not cause hypoglycaemia. The objectives of this study were to determine the effects of exogenous GIP infusion on blood glucose concentrations, glucose absorption, insulinaemia and gastric emptying in critically ill patients without known diabetes. Methods A total of 20 ventilated patients (Median age 61 (range: 22 to 79) years, APACHE II 21.5 (17 to 26), BMI 28 (21 to 40) kg/m2) without known diabetes were studied on two consecutive days in a randomised, double blind, placebo controlled, cross-over fashion. Intravenous GIP (4 pmol/kg/min) or placebo (0.9% saline) was infused between T鈥?鈥夆垝60 to 300聽minutes. At T0, 100聽ml of liquid nutrient (2聽kcal/ml) containing 3-O-Methylglucose (3-OMG), 100 mcg of Octanoic acid and 20聽MBq Tc-99聽m Calcium Phytate, was administered via a nasogastric tube. Blood glucose and serum 3-OMG (an index of glucose absorption) concentrations were measured. Gastric emptying, insulin and glucagon levels and plasma GIP concentrations were also measured. Results While administration of GIP increased plasma GIP concentrations three- to four-fold (T鈥?鈥夆垝60 23.9 (16.5 to 36.7) versus T鈥?鈥? 84.2 (65.3 to 111.1); P 300 4217 (1891 to 7715) versus 1232 (293 to 4545) pg/ml.300聽minutes; P鈥?鈥?.04), there were no effects on postprandial blood glucose (AUC300 2843 (2568 to 3338) versus 2819 (2550 to 3497) mmol/L.300聽minutes; P鈥?鈥?.86), gastric emptying (AUC300 15611 (10993 to 18062) versus 15660 (9694 to 22618) %.300聽minutes; P鈥?鈥?.61), glucose absorption (AUC300 50.6 (22.3 to 74.2) versus 64.3 (9.9 to 96.3) mmol/L.300聽minutes; P鈥?鈥?.62) or plasma insulin (AUC300 3945 (2280 to 6731) versus 3479 (2316 to 6081) mU/L.300聽minutes; P鈥?鈥?.76). Conclusions In contrast to its profound insulinotropic effect in health, the administration of GIP at pharmacological doses does not appear to affect glycaemia, gastric emptying, glucose absorption or insulinaemia in the critically ill patient. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12612000488808. Registered 3 May 2012.