Insulin Resistance in ICU Patients: Women Have Stronger Metabolic Response (2020)

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Type of Content
Journal ArticlePublisher
Elsevier BVISSN
2405-8963Language
enCollections
Abstract
Glycaemic control (GC) has been associated with improved outcomes in critically ill patients. However, inter- and intra- patient metabolic variability significantly increase the risk of hypoglycaemia when using insulin to control glycaemia. Model-based protocols often identify key physiological parameters from patient data, and demonstrated safe and effective GC. Based on recent studies showing gender difference in insulin secretion, this study uses retrospective data to identify whether there exists a difference in sexes in metabolic stress response, and thus in how personalised GC is given. Retrospective data from 145 ICU patients under GC who started GC in the first 12 hours of ICU stay are used. Insulin sensitivity (SI) is identified hourly, as well as the hour-to-hour percentage change in SI (%ΔSI). Differences between males and females SI and %ΔSI over 6-h blocks are compared using hypothesis and equivalence testing. A difference in SI levels would suggest a difference in metabolic stress response to insult, while a difference in %ΔSI levels would suggest a resulting difference in the difficulty to control. Results show females are significantly more insulin resistant than males and not equivalent, suggesting stronger stress response to insult induced stress. Metabolic variability is equivalent in both groups, advocating GC safety and efficacy should be similar between males and females, despite potential higher insulin rates required for females. This study is the first to suggest potential gender differences in the metabolic stress response.
Citation
Uyttendaele V, Knopp JL, Gottlieb R, Shaw GM, Desaive T, Chase JG (2020). Insulin Resistance in ICU Patients: Women Have Stronger Metabolic Response. IFAC-PapersOnLine. 53(2). 16203-16208.This citation is automatically generated and may be unreliable. Use as a guide only.
Keywords
glycaemic control; insulin; insulin resistance; insulin sensitivity; metabolic variabilityANZSRC Fields of Research
32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive care32 - Biomedical and clinical sciences::3202 - Clinical sciences::320208 - Endocrinology
32 - Biomedical and clinical sciences::3208 - Medical physiology::320803 - Systems physiology
40 - Engineering::4003 - Biomedical engineering::400306 - Computational physiology
Rights
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Higher Insulin Resistance in Female ICU patients
Gottlieb R; Shaw, Geoff; Desaive T; Chase, Geoff; Knopp, Jennifer; Uyttendaele, Vincent (BMC, 2020)Introduction: Sex differences in the metabolic response to critical illness are unknown. This retrospective analysis examines potential differences in the evolution of insulin sensitivity (SI) and its variability (%ΔSI) ... -
STAR-Liège: Modulating insulin AND nutrition improves glycaemic control
Pirotte M; Morimont P; Lambermont B; Shaw, Geoff; Desaive T; Uyttendaele, Vincent; Knopp, Jennifer; Chase, Geoff (BMC, 2020)Introduction: Stress-induced hyperglycemia is a common complication associated with higher morbidity and mortality in ICU patients. The Stochastic TARgeted (STAR) glycemic control (GC) framework provides consistent, ... -
Insulin sensitivity in critically ill patients: are women more insulin resistant?
Uyttendaele V; Gottlieb R; Desaive T; Chase, Geoff; Knopp, Jennifer; Shaw, G.M. (Springer Science and Business Media LLC, 2021)Glycaemic control (GC) in intensive care unit is challenging due to significant inter- and intra-patient variability, leading to increased risk of hypoglycaemia. Recent work showed higher insulin resistance in female preterm ...