The effect of insulin administration on c-peptide in critically ill patients with type 2 diabetes
AuthorCrisman, M; Lucchetta, L; Luethi, N; Cioccari, L; Lam, Q; Eastwood, GM; Bellomo, R; Martensson, J
Source TitleAnnals of Intensive Care
University of Melbourne Author/sBellomo, Rinaldo
AffiliationMelbourne Medical School
Document TypeJournal Article
CitationsCrisman, M., Lucchetta, L., Luethi, N., Cioccari, L., Lam, Q., Eastwood, G. M., Bellomo, R. & Martensson, J. (2017). The effect of insulin administration on c-peptide in critically ill patients with type 2 diabetes. ANNALS OF INTENSIVE CARE, 7 (1), https://doi.org/10.1186/s13613-017-0274-5.
Access StatusOpen Access
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).
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