50506
document
Effect of intensive insulin therapy on the somatotropic axis of critically ill children . CONTEXT Intensive insulin therapy ( IIT ) improved outcome in the adult and pediatric intensive care unit ( PICU ) compared with conventional insulin therapy ( CIT ) . IIT did not increase the anabolic hormone IGF-I in critically ill adults , but feeding in critically ill children and pediatric hormonal responses may differ . Twenty-five percent of the children with IIT experienced hypoglycemia , which may have evoked counterregulatory responses . OBJECTIVE We hypothesized that IIT reactivates the somatotropic axis and anabolism in PICU patients . DESIGN This was a preplanned subanalysis of a randomized controlled trial on IIT . PATIENTS We studied 369 patients who stayed in PICU for at least 3 d ( study 1 ) and 126 patients in a nested case-control study ( study 2 ) . MAIN OUTCOME MEASURES Circulating insulin , C-peptide , GH , IGF-I , bioavailable IGF-I , IGF-binding protein ( IGFBP ) -1 , IGFBP-3 , and acid-labile subunit were analyzed upon admission and d 3 . In the nested case-control study , the somatotropic axis , cortisol , and glucagon were analyzed before and after hypoglycemia . RESULTS On d 3 , C-peptide was more than 10-fold lower ( P < 0.0001 ) in the IIT group than in the CIT group . IIT increased circulating GH ( P = 0.04 ) and lowered bioavailable IGF-I ( P = 0.002 ) . IIT also decreased IGFBP-3 ( P = 0.0005 ) and acid-labile subunit ( P = 0.007 ) , while increasing IGFBP-1 ( P = 0.04 ) and the urea/creatinine ratio , a marker of catabolism ( P = 0.03 ) . In the nested case-control study , IGFBP-1 was increased after hypoglycemia , whereas the somatotropic axis and the counterregulatory hormones cortisol and glucagon did not change . CONCLUSIONS Despite improved PICU outcome , IIT did not counteract the catabolic state of critical illness . Suppression of portal insulin may have resulted in lower bioavailable IGF-I .
50507
Intervention_Pharmacological
intensive insulin therapy
50508
Intervention_Pharmacological
Intensive insulin therapy ( IIT )
50509
Intervention_Pharmacological
conventional insulin therapy ( CIT )
50510
Intervention_Pharmacological
IIT
50511
Intervention_Pharmacological
IIT
50512
Intervention_Pharmacological
IIT
50513
Intervention_Pharmacological
IIT
50514
Intervention_Pharmacological
CIT
50515
Intervention_Pharmacological
IIT
50516
Intervention_Pharmacological
IIT
50517
Intervention_Pharmacological
IIT
50518
Outcome_Physical
anabolism
50519
Outcome_Physical
insulin
50520
Outcome_Physical
C-peptide
50521
Outcome_Physical
GH
50522
Outcome_Physical
IGF-I
50523
Outcome_Physical
bioavailable IGF-I
50524
Outcome_Physical
IGF-binding protein ( IGFBP ) -1
50525
Outcome_Physical
IGFBP-3
50526
Outcome_Physical
acid-labile subunit
50527
Outcome_Physical
cortisol
50528
Outcome_Physical
glucagon
50529
Outcome_Physical
C-peptide
50530
Outcome_Physical
circulating GH
50531
Outcome_Physical
bioavailable IGF-I
50532
Outcome_Physical
IGFBP-3
50533
Outcome_Physical
acid-labile subunit
50534
Outcome_Physical
IGFBP-1
50535
Outcome_Physical
urea/creatinine ratio
50536
Outcome_Physical
IGFBP-1
50537
Outcome_Physical
cortisol and glucagon
50538
Outcome_Physical
catabolic state of critical illness
50539
Participant_Condition
critically ill
50540
Participant_Age
children
50541
Participant_Age
children
50542
Participant_Condition
hypoglycemia
50543
Participant_Sample-size
369
50544
Participant_Sample-size
126