Studying the effect of parenterally administered l-alanyl l-glutamine dipeptide in diabetes and new onset diabetes in liver transplantation

Abstract

ObjectiveThe objective of this study was to evaluate the efficacy of using alanine–glutamine (Aln–Gln) dipeptide as a supplement to control diabetes in liver transplanted patients.Patients and methodsEighty patients aged >18 yr admitted to ICU after receiving right lobe living donor liver transplantation (LDLT), had a previous history of diabetes or had a new onset diabetes (NODM) were enrolled in this prospective randomized double blind study. Patients were randomized into two groups and assigned to receive parenterally an equal dose of amino acids either with alanyl-glutamine dipeptide in the dose of 0.5 g/kg/d (group AG) or without alanyl-glutamine dipeptide (control group C). This regimen started at day 1 postoperative in diabetic patients or when new onset diabetes has been diagnosed in non-diabetic and continued till day 9 with measuring the incidence of hyperglycemia, hyperglycemic episodes, total insulin requirements/day, infectious episodes, ICU and hospital length of stay, and 6 month mortality rate.ResultsThe hyperglycemic episodes were significantly less in AG group patients than in control group patients (29 vs 38). Hyperglycemia requiring insulin therapy in AG group was significantly less (22 vs 28 patients). Also those who required decreasing TPN requirements were significantly lesser in the AG group (7 vs 11 patients). Insulin requirements per day in the AG group were significantly lower (53 ± 11 vs 78 ± 9 IU). The number of episodes of nosocomial infection per patient was lower in the AG group than in the control group (20 vs 28). The decrease in nosocomial infections in patients receiving AG was related mainly to a decrease in the incidence of pneumonia (7 vs 11). The ICU length of stay (LOS) was significantly lower in the AG group than in the control group (7.81 ± 2.98 vs 10.43 ± 4.67 day)ConclusionOur study showed that using AG supplementation in liver transplanted patients who have either a history of diabetes or NODM, reduces the insulin requirements, hyperglycemic episodes, infectious events and ICU stay.