Relationship between hyperglycemia and pancreatic beta cell dysfunction in critically ill children

Abstract

Objective To analyse the relationship between insulin resistance and the pancreatic beta cell dysfunction in critically ill children with hyperglycemia, to investigate the relationship between the pancreas injury and pancreatic beta cells dysfunction. Methods Seven hundred and thirty-six critically ill children admitted in PICU of Hunan Children′s Hospital from Nov 2012 to Mar 2013 were reviewed and analyzed. According to the maximum intravenous blood glucose within 24 h after admission, they were divided into severely elevated group (blood glucose ≥11.1 mmol/L, n=67), slightly elevated group (blood glucose 6.1~11.1 mmol/L, n=361) and control group (blood glucose≤6.1 mmo/L, n=308). Serum insulin, C peptide, serum amylase, lipase, urinary amylase, HOMA-β, HOMA-IR were compared among 3 groups. According to the severity of sepsis, they were divided into non-sepsis group (n=414), sepsis group (n=237), severe sepsis group (n=64), septic shock group (n=21). Blood glucose, serum insulin, C peptide, HOMA-β and HOMA-IR were compared among 4 groups. Results (1) The levels of insulin, C peptide, blood amylase, lipase and urine amylase were gradually increased with elevated blood sugar (rs=0.235, P 0.05). The levels of blood sugar increased to 9.21 (6.21-19.60) mmol/L, HOMA-β declined to 10.52% in septic shock group, and blood glucose, insulin, C peptide, HOMA-β were significantly different compared with the other 3 groups (P<0.05). Conclusion Hyperglycemia is associated with insulin resistance and pancreatic β cells dysfunction in critically ill children, the cause of beta cell dysfunction is secondary to pancreatic injury. Pancreatic beta cells dysfunction inducing hyperglycemia is more significant than insulin resistance in sepsis children. Key words: Hyperglycemia; Beta cell dysfunction; Insulin resistance; Sepsis; Children