Back to Search
Start Over
Effect of intensive insulin therapy on the somatotropic axis of critically ill children.
- Source :
-
The Journal of clinical endocrinology and metabolism [J Clin Endocrinol Metab] 2011 Aug; Vol. 96 (8), pp. 2558-66. Date of Electronic Publication: 2011 Jun 01. - Publication Year :
- 2011
-
Abstract
- Context: Intensive insulin therapy (IIT) improved outcome in the adult and pediatric intensive care unit (PICU) compared with conventional insulin therapy (CIT). IIT did not increase the anabolic hormone IGF-I in critically ill adults, but feeding in critically ill children and pediatric hormonal responses may differ. Twenty-five percent of the children with IIT experienced hypoglycemia, which may have evoked counterregulatory responses.<br />Objective: We hypothesized that IIT reactivates the somatotropic axis and anabolism in PICU patients.<br />Design: This was a preplanned subanalysis of a randomized controlled trial on IIT.<br />Patients: We studied 369 patients who stayed in PICU for at least 3 d (study 1) and 126 patients in a nested case-control study (study 2).<br />Main Outcome Measures: Circulating insulin, C-peptide, GH, IGF-I, bioavailable IGF-I, IGF-binding protein (IGFBP)-1, IGFBP-3, and acid-labile subunit were analyzed upon admission and d 3. In the nested case-control study, the somatotropic axis, cortisol, and glucagon were analyzed before and after hypoglycemia.<br />Results: On d 3, C-peptide was more than 10-fold lower (P < 0.0001) in the IIT group than in the CIT group. IIT increased circulating GH (P = 0.04) and lowered bioavailable IGF-I (P = 0.002). IIT also decreased IGFBP-3 (P = 0.0005) and acid-labile subunit (P = 0.007), while increasing IGFBP-1 (P = 0.04) and the urea/creatinine ratio, a marker of catabolism (P = 0.03). In the nested case-control study, IGFBP-1 was increased after hypoglycemia, whereas the somatotropic axis and the counterregulatory hormones cortisol and glucagon did not change.<br />Conclusions: Despite improved PICU outcome, IIT did not counteract the catabolic state of critical illness. Suppression of portal insulin may have resulted in lower bioavailable IGF-I.
- Subjects :
- Adolescent
C-Peptide blood
Case-Control Studies
Child
Child, Preschool
Female
Glucagon blood
Humans
Hydrocortisone blood
Hypoglycemia chemically induced
Hypoglycemic Agents adverse effects
Hypoglycemic Agents blood
Infant
Infant, Newborn
Insulin adverse effects
Insulin blood
Insulin-Like Growth Factor Binding Protein 1 blood
Insulin-Like Growth Factor Binding Protein 3
Insulin-Like Growth Factor Binding Proteins metabolism
Intensive Care Units, Pediatric
Male
Prospective Studies
Critical Illness therapy
Human Growth Hormone blood
Hypoglycemia metabolism
Hypoglycemic Agents administration & dosage
Insulin administration & dosage
Insulin-Like Growth Factor I metabolism
Subjects
Details
- Language :
- English
- ISSN :
- 1945-7197
- Volume :
- 96
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- The Journal of clinical endocrinology and metabolism
- Publication Type :
- Academic Journal
- Accession number :
- 21632816
- Full Text :
- https://doi.org/10.1210/jc.2010-3045