Impact of glucocorticoids on insulin resistance in the critically ill (2011)
Type of ContentJournal Article
PublisherUniversity of Canterbury. Mathematics and Statistics
University of Canterbury. Mechanical Engineering
AuthorsPretty, C.G., Chase, J.G., Lin, J., Shaw, G.M., Le Compte, A.J., Razak, N., Parente, J.D.show all
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.
CitationPretty, C.G., Chase, J.G., Lin, J., Shaw, G.M., Le Compte, A.J., Razak, N., Parente, J.D. (2011) Impact of glucocorticoids on insulin resistance in the critically ill. Computer Methods and Programs in Biomedicine, 102(2), pp. 172-180.
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Keywordscritical care; hyperglycaemia; insulin resistance; glucocorticoids; mathematical model; algorithms
ANZSRC Fields of Research11 - Medical and Health Sciences::1103 - Clinical Sciences::110310 - Intensive Care
11 - Medical and Health Sciences::1103 - Clinical Sciences::110306 - Endocrinology
11 - Medical and Health Sciences::1102 - Cardiovascular Medicine and Haematology::110202 - Haematology
09 - Engineering::0903 - Biomedical Engineering::090302 - Biomechanical Engineering
01 - Mathematical Sciences