• Admin
    UC Research Repository
    View Item 
       
    • UC Home
    • Library
    • UC Research Repository
    • College of Engineering
    • Engineering: Journal Articles
    • View Item
       
    • UC Home
    • Library
    • UC Research Repository
    • College of Engineering
    • Engineering: Journal Articles
    • View Item
    JavaScript is disabled for your browser. Some features of this site may not work without it.

    Browse

    All of the RepositoryCommunities & CollectionsBy Issue DateAuthorsTitlesSubjectsThis CollectionBy Issue DateAuthorsTitlesSubjects

    Statistics

    View Usage Statistics

    Impact of glucocorticoids on insulin resistance in the critically ill

    Thumbnail
    View/Open
    12635865_Impact of glucocorticoids on insulin resistance in the critically ill-CMPB-v2_REVISED - FINAL.pdf (1.019Mb)
    Author
    Pretty, C.G.
    Chase, J.G.
    Lin, J.
    Shaw, G.M.
    Le Compte, A.J.
    Razak, N.
    Parente, J.D.
    Date
    2011
    Permanent Link
    http://hdl.handle.net/10092/6321

    Glucocorticoids (GCs) have been shown to reduce insulin sensitivity in healthy individuals. Widely used in critical care to treat a variety of inflammatory and allergic disorders, they may inadvertently exacerbate stress-hyperglycaemia. This research uses model-based methods to quantify the reduction of insulin sensitivity from GCs in critically ill patients, and thus their impact on glycaemic control. A clinically validated model-based measure of insulin sensitivity (SI) was used to quantify changes between two matched cohorts of 40 intensive care unit (ICU) patients who received GCs and a control cohort who did not. All patients were admitted to the Christchurch hospital ICU between 2005 and 2007 and spent at least 24 hours on the SPRINT glycaemic control protocol. A 31% reduction in whole-cohort median insulin sensitivity was seen between the control cohort and patients receiving glucocorticoids with a median dose equivalent to 200mg/day of hydrocortisone per patient. Comparing percentile-patients as a surrogate for matched patients, reductions in median insulin sensitivity of 20, 25, and 21% were observed for the 25th, 50th and 75th-percentile patients. All these cohort and per-patient reductions are less than or equivalent to the 30-62% reductions reported in healthy subjects especially when considering the fact that the GC doses in this study are 1.3-4 times larger than those in studies of healthy subjects. This reduced suppression of insulin sensitivity in critically ill patients could be a result of saturation due to already increased levels of catecholamines and cortisol common in critically illness. Virtual trial simulation showed that reductions in insulin sensitivity of 20-30% associated with glucocorticoid treatment in the ICU have limited impact on glycaemic control levels within the context of the SPRINT protocol.

    Subjects
    critical care
     
    hyperglycaemia
     
    insulin resistance
     
    glucocorticoids
     
    mathematical model
     
    algorithms
     
    Field of Research::11 - Medical and Health Sciences::1103 - Clinical Sciences::110310 - Intensive Care
     
    Field of Research::11 - Medical and Health Sciences::1103 - Clinical Sciences::110306 - Endocrinology
     
    Field of Research::11 - Medical and Health Sciences::1102 - Cardiovascular Medicine and Haematology::110202 - Haematology
     
    Field of Research::09 - Engineering::0903 - Biomedical Engineering::090302 - Biomechanical Engineering
     
    Field of Research::01 - Mathematical Sciences
    Collections
    • Engineering: Journal Articles [932]
    Rights
    http://library.canterbury.ac.nz/ir/rights.shtml

    UC Research Repository
    University Library
    University of Canterbury
    Private Bag 4800
    Christchurch 8140

    Phone
    364 2987 ext 8718

    Email
    ucresearchrepository@canterbury.ac.nz

    Follow us
    FacebookTwitterYoutube

    © University of Canterbury Library
    Send Feedback | Contact Us