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Related Experiment Video

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Improving IV Insulin Administration in a Community Hospital
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The incretin effect in critically ill patients: a case-control study.

Signe Tellerup Nielsen1, Susanne Janum2,3, Rikke Krogh-Madsen4

  • 1Centre of Inflammation and Metabolism and the Centre for Physical Activity Research, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark. signenielsen@dadlnet.dk.

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Summary

Critically ill patients have a reduced incretin effect, similar to those with type 2 diabetes. This impairment in glucose-dependent insulin secretion may contribute to hyperglycemia in critical illness.

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Area of Science:

  • Endocrinology
  • Critical Care Medicine
  • Metabolism

Background:

  • Critically ill patients frequently experience hyperglycemia, with unclear underlying mechanisms.
  • Type 2 diabetes and critical illness share similarities like hyperglycemia, insulin resistance, and inflammation.
  • Previous research suggests exogenous glucagon-like peptide (GLP)-1 benefits glycemic control in critically ill patients.

Purpose of the Study:

  • To investigate the hypothesis that the incretin effect is impaired in critically ill patients.
  • To compare the incretin effect in critically ill patients versus healthy controls.

Main Methods:

  • Cross-sectional case-control study design.
  • Inclusion of eight critically ill patients and eight healthy controls matched for age, sex, and BMI.
  • Oral glucose tolerance test (OGTT) followed by intravenous glucose infusion (IVGI) to assess insulin secretion and incretin hormone levels (GLP-1, GIP).

Main Results:

  • Critically ill patients exhibited higher levels of proinflammatory cytokines (TNF-α, IL-6) compared to controls.
  • While GIP and glucagon responses were higher in patients, GLP-1 response did not differ.
  • The incretin effect was significantly lower in critically ill patients (23%) compared to controls (57%).

Conclusions:

  • The incretin effect is reduced in critically ill patients.
  • This finding is consistent with observations in patients with type 2 diabetes.
  • The impaired incretin effect may contribute to hyperglycemia in critical illness.