Reference : Observation of incretin effects during enteral feed transitions of critically ill patients
Scientific journals : Article
Human health sciences : Anesthesia & intensive care
http://hdl.handle.net/2268/132033
Observation of incretin effects during enteral feed transitions of critically ill patients
English
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 mailto [Université de Liège - ULg > Département d'astrophys., géophysique et océanographie (AGO) > Thermodynamique des phénomènes irréversibles >]
Preiser, J.-C. [Department of Intensive Care, Erasme University Hospital, Brussels, Belgium]
2012
e-SPEN Journal
7
4
e154-e159
Yes
International
22128263
[en] Enteral feed transition ; Enteral nutrition ; Incretin effect ; Insulin sensitivity ; Specialized Relative Insulin Nutrition Titration ; Tight glycaemic control
[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.
http://hdl.handle.net/2268/132033
10.1016/j.clnme.2012.05.002

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