incretins and Burns

This systematic review investigated the effectiveness and safety of intensive insulin therapy (IIT), insulin secretagogues and sensitisers in burn patients. PubMed, Embase, clinicaltrials.gov and Cochrane central were searched from 1990 to 2016. Title/abstract screening, full-text review, critical appraisal and data extraction were carried out by two independent reviewers. Inclusion criteria were hospitalised burn patients, IIT, insulin sensitisers or secretagogues and the outcomes mortality, length of stay, resting energy expenditure, blood glucose, catabolism, or complications. We identified 594 potential studies of which 13 were included. Five studies investigated IIT in paediatric patients, 3 investigated IIT in adults and 5 investigated sensitisers or secretagogues. Glycaemic targets differed with age group - paediatric studies compared IIT to loose glycaemic control while adult studies compared IIT to more moderate control. Meta-analyses were limited by differences in outcome reporting, however mortality was increased in children by loose glycaemic control (OR=3.78, 95%CI 1.19-12.02) but not significantly affected in adults by moderate compared to tight control. Meta-analyses could not be performed for sensitisers or secretagogues. These findings support recommendations that moderate insulin administration (130-150mg/dL) is the prudent approach in burn patients. The evidence is relatively sparse and further research is warranted.

Topics: Burns; Dipeptidyl-Peptidase IV Inhibitors; Disease Management; Exenatide; Glipizide; Humans; Hyperglycemia; Hypoglycemic Agents; Incretins; Insulin; Insulin Resistance; Metformin; Pioglitazone; Rosiglitazone; Secretagogues; Sulfonylurea Compounds

Hyperglycemia with insulin resistance is commonly seen in severely burned patients and tight glycemia control with insulin may be beneficial in this condition. The most potent insulinotropic hormone, glucagon-like peptide 1 (GLP-1), stimulates insulin secretion in a glucose-dependent manner. Because infusion of GLP-1 never reduces glucose levels to below ∼70 mg/dL, the risk of hypoglycemia by using insulin is reduced. In this study we investigated the metabolic effects of GLP-1 infusion after burn injury in an animal model.. Male CD rats were divided in 3 groups: burn injury with saline, burn injury with GLP-1 treatment, and sham burn (SB). Burn injury was full thickness 40% total body surface area. The burn injury with GLP-1 treatment group received GLP-1 infusion via osmotic pump. Fasting blood glucose, plasma insulin, and plasma GLP-1 levels were measured during intraperitoneal glucose tolerance tests. Expressions of caspase 3 and bcl-2 were evaluated in pancreatic islets. In a subset of animals, protein metabolism and total energy expenditure were measured.. Fasting GLP-1 was reduced in burn injury with saline compared to SB or burn injury with GLP-1 treatment. Burn injury with GLP-1 treatment showed reduced fasting blood glucose, improved intraperitoneal glucose tolerance test results, with increased plasma insulin and GLP-1 responses to glucose. GLP-1 reduced protein breakdown and total energy expenditure in burn injury with GLP-1 treatment versus burn injury with saline, with improved protein balance. Increased expression of caspase 3 and decreased expression of bcl-2 in islet cells by burn injury were ameliorated by GLP-1.. Burn injury reduced plasma GLP-1 in association with insulin resistance. GLP-1 infusion improved glucose tolerance and showed anabolic effects on protein metabolism and reduced total energy expenditure after burn injury, possibly via insulinotropic and non insulinotropic mechanisms.

Topics: Animals; Blood Glucose; Burns; Caspase 3; Energy Metabolism; Glucagon-Like Peptide 1; Hyperglycemia; Incretins; Insulin; Insulin Resistance; Islets of Langerhans; Male; Models, Animal; Proto-Oncogene Proteins c-bcl-2; Rats; Rats, Inbred Strains