Regulation of the somatotropic axis by intensive insulin therapy during protracted critical illness

The Journal of Clinical Endocrinology and Metabolism
Dieter MesottenGreet Van den Berghe

Abstract

The catabolic state of critical illness has been linked to the suppressed somatotropic GH-IGF-binding protein (IGFBP) axis. In critically ill patients it has been demonstrated that, compared with the conventional approach, which only recommended insulin therapy when blood glucose levels exceeded 12 mmol/liter, strict maintenance of blood glucose levels below 6.1 mmol/liter with intensive insulin therapy almost halved intensive care mortality, acute renal failure, critical illness polyneuropathy, and bloodstream infections. Poor blood glucose control in diabetes mellitus has also been associated with low serum IGF-I levels, which can be increased by insulin therapy. We hypothesized that intensive insulin therapy would improve the IGF-I axis, possibly contributing to the clinical correlates of anabolism. Therefore, this study of 363 patients, requiring intensive care for more than 7 d and randomly assigned to either conventional or intensive insulin therapy, examines the effects of intensive insulin therapy on the somatotropic axis. Contrary to expectation, intensive insulin therapy suppressed serum IGF-I, IGFBP-3, and acid-labile subunit concentrations. This effect was independent of survival of the critically ill patient. Conco...Continue Reading

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Citations

Dec 9, 2004·Current Opinion in Clinical Nutrition and Metabolic Care·Jeffrey I Mechanick, Elise M Brett
Jul 15, 2005·Current Opinion in Critical Care·Ilse VanhorebeekGreet Van den Berghe
Jun 30, 2009·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·David J MarquardtMark W Hall
Mar 28, 2006·Thorax·S J Finney, T W Evans
Oct 22, 2005·American Journal of Respiratory and Critical Care Medicine·Moritoki EgiSamantha Bates
Aug 9, 2012·The Journal of Clinical Endocrinology and Metabolism·Marijke GielenGreet Van den Berghe
Mar 16, 2013·Acta neurochirurgica·Maria ZetterlingElisabeth Ronne-Engström
Jun 1, 2011·Critical Care Nursing Clinics of North America·Kay Lawrence
Jan 30, 2010·Best Practice & Research. Clinical Anaesthesiology·S J Van Cromphaut
Jan 30, 2010·Best Practice & Research. Clinical Anaesthesiology·Ilse Vanhorebeek, Lies Langouche
Oct 24, 2007·Clinical Nutrition : Official Journal of the European Society of Parenteral and Enteral Nutrition·Sascha C A T VerbruggenJohannes B van Goudoever
Aug 22, 2007·Growth Hormone & IGF Research : Official Journal of the Growth Hormone Research Society and the International IGF Research Society·Frantisek DuskaJan Pachl
Mar 31, 2007·Seminars in Thoracic and Cardiovascular Surgery·Ilse VanhorebeekGreet Van den Berghe
Jan 10, 2006·Critical Care Clinics·Dieter Mesotten, Greet Van den Berghe
Jan 10, 2006·Critical Care Clinics·Teng Teng Chung, Charles J Hinds
Nov 28, 2006·Endocrinology and Metabolism Clinics of North America·Dieter Mesotten, Greet Van den Berghe
Nov 28, 2006·Endocrinology and Metabolism Clinics of North America·Ilse Vanhorebeek, Greet Van den Berghe
Apr 19, 2005·European Journal of Internal Medicine·Björn EllgerGreet Van den Berghe
Nov 3, 2004·The Journal of Clinical Investigation·Greet Van den Berghe
Nov 5, 2004·Current Opinion in Pharmacology·Ilse Vanhorebeek, Greet Van den Berghe
Feb 27, 2018·Current Diabetes Reports·Ilse VanhorebeekGreet Van den Berghe
Jul 31, 2019·The Journal of Clinical Endocrinology and Metabolism·Lisa Van DyckIlse Vanhorebeek
Nov 16, 2016·Pediatric Critical Care Medicine : a Journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies·Ricardo G BrancoRobert C Tasker

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