Exogenous glucagon-like peptide-1 attenuates the glycaemic response to postpyloric nutrient infusion in critically ill patients with type-2 diabetes.docVIP

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Exogenous glucagon-like peptide-1 attenuates the glycaemic response to postpyloric nutrient infusion in critically ill patients with type-2 diabetes.doc

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Exogenous glucagon-like peptide-1 attenuates the glycaemic response to postpyloric nutrient infusion in critically ill patients with type-2 diabetes

Deaneetal.CriticalCare2011,15:R35 /content/15/1/R35 RESEARCH OpenAccess Exogenousglucagon-likepeptide-1attenuates theglycaemicresponsetopostpyloricnutrient infusionincriticallyillpatientswithtype-2 diabetes AdamMDeane1,2,3*,MatthewJSummers2,AntonyVZaknic2,MarianneJChapman1,2,3,RobertJLFraser3,4,5 AnnaEDiBartolomeo1,JudithMWishart4,MichaelHorowitz4 , Abstract Introduction:Glucagon-likepeptide-1(GLP-1)attenuatestheglycaemicresponsetosmallintestinalnutrient infusioninstress-inducedhyperglycaemiaandreducesfastingglucoseconcentrationsincriticallyillpatientswith type-2diabetes.TheobjectiveofthisstudywastoevaluatetheeffectsofacuteadministrationofGLP-1onthe glycaemicresponsetosmallintestinalnutrientinfusionincriticallyillpatientswithpre-existingtype-2diabetes. Methods:Elevencriticallyillmechanically-ventilatedpatientswithknowntype-2diabetesreceivedintravenous infusionsofGLP-1(1.2pmol/kg/minute)andplacebofromt=0to270minutesonseparatedaysinrandomised double-blindfashion.Betweent=30to270minutesaliquidnutrientwasinfusedintraduodenallyatarateof 1kcal/minviaanaso-entericcatheter.Bloodglucose,seruminsulinandC-peptide,andplasmaglucagonwere measured.Dataaremean±SEM. Results:GLP-1attenuatedtheoverallglycaemicresponsetonutrient(bloodglucoseAUC30-270 min:GLP-12,244± 184vs.placebo2,679±233mmol/l/minute;P=0.02).Bloodglucosewasmaintainedat10mmol/lin6/11 patientswhenreceivingGLP-1and4/11withplacebo.GLP-1increasedseruminsulinat270minutes(GLP-1:23.4± 6.7vs.placebo:16.4±5.5mU/l;P0.05),buthadnoeffectonthechangeinplasmaglucagon. Conclusions:ExogenousGLP-1inadoseof1.2pmol/kg/minuteattenuatestheglycaemicresponsetosmall intestinalnutrientincriticallyillpatientswithtype-2diabetes.Giventhemodestmagnitudeofthereductionin glycaemiatheeffectsofGLP-1athigherdosesand/orwhenadministeredincombinationwithinsulin,warrant evaluationinthisgroup. Trialregistration:ANZCTR:ACTRN12610000185066 Introduction vulnerable to the toxicity of hyperglycaemia [2]. The Themanagementofhyperglycaemiainthecritically