Article (Scientific journals)
Observation of incretin effects during enteral feed transitions of critically ill patients
Jamaludin, U. K.; Docherty, P. D.; Geoffrey Chase, J. et al.
2012In e-SPEN Journal, 7 (4), p. 154-e159
Peer reviewed
 

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Keywords :
Enteral feed transition; Enteral nutrition; Incretin effect; Insulin sensitivity; Specialized Relative Insulin Nutrition Titration; Tight glycaemic control
Abstract :
[en] Background & aims: Critically ill patients are regularly feed via constant enteral (EN) nutrition infusions. However, the incretin effect or its impact on endogenous insulin concentration remains unclear. This study determines whether there is an EN-driven incretin effect in critically ill patients requiring glycaemic control. Methods: Clinically validated, model-based time-variant insulin sensitivity (S I) profiles were identified for 52 non-diabetic patients on Specialized Relative Insulin Nutrition Titration (SPRINT) glycaemic control during transitions off EN (ON/OFF), and back on to EN (OFF/ON). Incretin effects were observable via increased modelled S I after the OFF/ON transition or a decreased S I after the ON/OFF transition. Results: Patients exhibited a median -36% (IQR -82% to 24% p = 0.001) reduction after the ON/OFF feed transition, and a median of +32% (IQR -5% to 53%, p = 0.05) rise in measured S I after the OFF/ON transition. However, 32% of patients exhibited increased S I at the OFF/ON transition, and 37% exhibited reduced S I at the ON/OFF transition. The results are likely due to changes in patient condition over the 5-8 h considered outweighing this effect. Blood glucose was the same during both transitions with median shifts of -2% and -3% after the ON/OFF, and OFF/ON transitions (p > 0.5), respectively. Conclusions: Results imply a significant incretin effect is observed at a cohort level. The impact was stronger for the OFF/ON transition indicating that this effect may be blunted by long-term continuous EN infusions. These results provide the data to design conclusive studies, and to inform glycaemic control protocol development and implementation. © 2012 European Society for Clinical Nutrition and Metabolism.
Disciplines :
Anesthesia & intensive care
Author, co-author :
Jamaludin, U. K.;  Department of Mechanical Engineering, Centre of Bioengineering, University of Canterbury, Christchurch, New Zealand
Docherty, P. D.;  Department of Mechanical Engineering, Centre of Bioengineering, University of Canterbury, Christchurch, New Zealand
Geoffrey Chase, J.;  Department of Mechanical Engineering, Centre of Bioengineering, University of Canterbury, Christchurch, New Zealand
Le Compte, A.;  Department of Mechanical Engineering, Centre of Bioengineering, University of Canterbury, Christchurch, New Zealand
Shaw, G. M.;  Department of Intensive Care, Christchurch Hospital, Christchurch School of Medicine, University of Otago, Christchurch, New Zealand
Desaive, Thomas  ;  Université de Liège - ULiège > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles
PREISER, Jean-Charles ;  Department of Intensive Care, Erasme University Hospital, Brussels, Belgium
Language :
English
Title :
Observation of incretin effects during enteral feed transitions of critically ill patients
Publication date :
2012
Journal title :
e-SPEN Journal
eISSN :
2212-8263
Publisher :
Elsevier, Netherlands
Volume :
7
Issue :
4
Pages :
e154-e159
Peer reviewed :
Peer reviewed
Available on ORBi :
since 11 October 2012

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