Skip to main content

Advertisement

Exogenous glucagon-like peptide 1: a potentially novel therapy for the management of hyperglycaemia in the critically ill

Introduction

The purpose of this study was to determine the effects of exogenous glucagon-like peptide 1 (GLP-1) on the glycaemic response to enteral nutrition in nondiabetic, critically ill patients. Exogenous GLP-1 lowers blood glucose concentrations in both healthy humans and patients with type 2 diabetes, via suppression of glucagon, stimulation of insulin secretion and slowing gastric emptying. As the humoral effects are glucose dependent, the use of GLP-1 is not associated with hypoglycaemia. The effects of GLP-1 on glycaemia in critical illness have hitherto not been evaluated.

Methods

Seven, nondiabetic, critically ill patients (four males, three females; age 58 ± 6 years) received, on two separate days, intravenous GLP-1 (1.2 pmol/kg/min) or placebo between t = 0 and 270 minutes, in randomised double-blind fashion. Between t = 30 and 270 minutes a liquid nutrient was infused intra-duodenally at a rate of 1.5 kcal/min. Blood glucose, plasma insulin and glucagon concentrations were measured. Data are presented as the mean ± SEM. Statistical analyses were performed using the paired t test or repeated-measures ANOVA.

Results

Compared with placebo, GLP-1 decreased peak glucose concentrations (10.1 ± 0.7 mmol/l vs. 12.7 ± 1.1 mmol/l; P = 0.01) and markedly attenuated the overall glycaemic response to enteral nutrition (blood glucose area under the curve 30 to 270 min, 2,077 ± 145 mmol/l/240 min vs. 2,568 ± 208 mmol/l/240 min; P < 0.02) (Figure 1). GLP-1 caused a transient, but nonsustained, suppression of plasma glucagon concentrations (t = 30 min, 90 ± 12 pmol/ml vs. 104 ± 10 pmol/ml; P < 0.01) and tended to increase the plasma insulin/blood glucose ratio (between t = 0 and 270 min, mean Δinsulin/glucose ratio 5.0 ± 2.0 mU/mmol vs. 2.5 ± 0.9 mU/mmol; P = 0.12).

Figure 1
figure1

Glycaemic response to enteral nutrition is markedly attenuated (** P < 0.02).

Conclusion

Acute, exogenous GLP-1 infusion markedly attenuates the glycaemic response to enteral nutrition in the critically ill. Exogenous GLP-1 represents a potentially novel therapy for the management of hyperglycaemia in the critically ill.

Author information

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Deane, A., Fraser, R., Horowitz, M. et al. Exogenous glucagon-like peptide 1: a potentially novel therapy for the management of hyperglycaemia in the critically ill. Crit Care 13, P126 (2009). https://doi.org/10.1186/cc7290

Download citation

Keywords

  • Glucagon
  • Enteral Nutrition
  • Blood Glucose Concentration
  • Lower Blood Glucose
  • Plasma Glucagon