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The effect of insulin administration on c-peptide in critically ill patients with type 2 diabetes.
- Source :
-
Annals of Intensive Care . 5/12/2017, Vol. 7 Issue 1, p1-8. 8p. - Publication Year :
- 2017
-
Abstract
- Background: In critically ill patients with permissive hyperglycemia, it is uncertain whether exogenous insulin administration suppresses or enhances c-peptide secretion (a marker of pancreatic beta-cell response). We aimed to explore this effect in patients with type 2 diabetes. Methods: We prospectively enrolled a cohort of 45 critically ill patients with type 2 diabetes managed according to a liberal glucose protocol (target blood glucose 10-14 mmol/l). We recorded the administration of insulin and oral hypoglycemic agents and measured plasma c-peptide as surrogate marker of endogenous insulin secretion on the first two consecutive days in ICU. Results: Overall, 20 (44.4%) patients required insulin to achieve target blood glucose. Insulin-treated patients had higher glycated hemoglobin A1c, more premorbid insulin-requiring type 2 diabetes, and greater blood glucose levels but lower c-peptide levels on admission. Premorbid insulin-requiring diabetes was independently associated with lower admission c-peptide, whereas greater plasma creatinine was independently associated with higher levels. Increases in c-peptide were positively correlated with an increase in blood glucose both in patients who did ( r = 0.54, P = 0.01) and did not ( r = 0.56, P = 0.004) receive insulin. However, insulin administration was independently associated with a greater increase in c-peptide ( P = 0.04). This association was not modified by the use of oral insulin secretagogues. Conclusions: C-peptide, a marker of beta-cell response, responds to and is influenced by glycemia and renal function in critically ill patients with type 2 diabetes. In addition, in our cohort, exogenous insulin administration was associated with a greater increase in c-peptide in response to hyperglycemia. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN12615000216516). [ABSTRACT FROM AUTHOR]
- Subjects :
- *HYPERGLYCEMIA
*INSULIN
*C-peptide
*TYPE 2 diabetes
*GLUCOSE
*PATIENTS
Subjects
Details
- Language :
- English
- ISSN :
- 21105820
- Volume :
- 7
- Issue :
- 1
- Database :
- Academic Search Index
- Journal :
- Annals of Intensive Care
- Publication Type :
- Academic Journal
- Accession number :
- 122987327
- Full Text :
- https://doi.org/10.1186/s13613-017-0274-5