Abstract
IntroductionIntensive insulin treatment (IIT) has been shown to improve outcomes post-burn in severely burnt patients. However, it increases the incidence of hypoglycemia and is associated with risks and complications. We hypothesized that exenatide would decrease plasma glucose levels post-burn to levels similar to those achieved with IIT, and reduce the amount of exogenous insulin administered.MethodsThis open-label study included 24 severely burned pediatric patients. Six were randomized to receive exenatide, and 18 received IIT during acute hospitalization (block randomization). Exenatide and insulin were administered to maintain glucose levels between 80 and 140 mg/dl. We determined 6 AM, daily average, maximum and minimum glucose levels. Variability was determined using mean amplitude of glucose excursions (MAGE) and percentage of coefficient of variability. The amount of administered insulin was compared in both groups.ResultsGlucose values and variability were similar in both groups: Daily average was 130 ± 28 mg/dl in the intervention group and 138 ± 25 mg/dl in the control group (P = 0.31), MAGE 41 ± 6 vs. 45 ± 12 (respectively). However, administered insulin was significantly lower in the exenatide group than in the IIT group: 22 ± 14 IU patients/day in the intervention group and 76 ± 11 IU patients/day in the control group (P = 0.01). The incidence rate of hypoglycemia was similar in both groups (0.38 events/patient-month).ConclusionsPatients receiving exenatide received significantly lower amounts of exogenous insulin to control plasma glucose levels. Exenatide was well tolerated and potentially represents a novel agent to attenuate hyperglycemia in the critical care setting.Trial registrationNCT00673309.
Highlights
Intensive insulin treatment (IIT) has been shown to improve outcomes post-burn in severely burnt patients
Demographics showed no significant difference between both groups (Table 1)
The number of glucose determinations was similar between both groups: 143 ± 38 for the exenatide group and 139 ± 59 for the IIT group (P = 0.79)
Summary
Intensive insulin treatment (IIT) has been shown to improve outcomes post-burn in severely burnt patients. It increases the incidence of hypoglycemia and is associated with risks and complications. We hypothesized that exenatide would decrease plasma glucose levels post-burn to levels similar to those achieved with IIT, and reduce the amount of exogenous insulin administered. The Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) found no benefit and an increased incidence of hypoglycemia with IIT in adult critical care [6,7]. Since current evidence supports the use of IIT in trauma patients, the study of novel therapies to decrease hyperglycemia in burn patients without increasing the risk of hypoglycemia is warranted [8]. Activation of the incretin receptors on b-cells increases insulin release in response to glucose [13] and may have additional beneficial effects, as it has been suggested that these drugs promote enhanced glucose disposal in peripheral tissues and protect against ischemia/reperfusion injury [14]
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