TY  - JOUR
AU  - Crisman, M
AU  - Lucchetta, L
AU  - Luethi, N
AU  - Cioccari, L
AU  - Lam, Q
AU  - Eastwood, GM
AU  - Bellomo, R
AU  - Martensson, J
Y2  - 2021/02/04
Y1  - 2017/05/12
SN  - 2110-5820
UR  - http://hdl.handle.net/11343/259264
AB  - 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).
LA  - English
PB  - SPRINGER HEIDELBERG
T1  - The effect of insulin administration on c-peptide in critically ill patients with type 2 diabetes
DO  - 10.1186/s13613-017-0274-5
IS  - Annals of Intensive Care
VL  - 7
IS  - 1
L1  - /bitstream/handle/11343/259264/PMC5427062.pdf?sequence=1&isAllowed=y
ER  -