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Increased insulin resistance in intensive care: longitudinal retrospective analysis of glycaemic control patients in a New Zealand ICU

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العنوان: Increased insulin resistance in intensive care: longitudinal retrospective analysis of glycaemic control patients in a New Zealand ICU
المؤلفون: Shaw GM, Knopp, Jennifer, Chase, Geoff
بيانات النشر: SAGE Publications
سنة النشر: 2022
المجموعة: University of Canterbury, Christchurch: UC Research Repository
مصطلحات موضوعية: glucose tolerance, insulin resistance, insulin sensitivity, intensive care, glycaemic control, Fields of Research::32 - Biomedical and clinical sciences::3202 - Clinical sciences::320208 - Endocrinology, Fields of Research::32 - Biomedical and clinical sciences::3202 - Clinical sciences::320212 - Intensive care, Fields of Research::40 - Engineering::4003 - Biomedical engineering::400305 - Biomedical instrumentation
الوصف: Background: Critical care populations experience demographic shifts in response to trends in population and healthcare, with increasing severity and/or complexity of illness a common observation worldwide. Inflammation in critical illness impacts glucose–insulin metabolism, and hyperglycaemia is associated with mortality and morbidity. This study examines longitudinal trends in insulin sensitivity across almost a decade of glycaemic control in a single unit. Methods: A clinically validated model of glucose–insulin dynamics is used to assess hour–hour insulin sensitivity over the first 72 h of insulin therapy. Insulin sensitivity and its hour–hour percent variability are examined over 8 calendar years alongside severity scores and diagnostics. Results: Insulin sensitivity was found to decrease by 50–55% from 2011 to 2015, and remain low from 2015 to 2018, with no concomitant trends in age, severity scores or risk of death, or diagnostic category. Insulin sensitivity variability was found to remain largely unchanged year to year and was clinically equivalent (95% confidence interval) at the median and interquartile range. Insulin resistance was associated with greater incidence of high insulin doses in the effect saturation range (6–8 U/h), with the 75th percentile of hourly insulin doses rising from 4–4.5 U/h in 2011–2014 to 6 U/h in 2015–2018. Conclusions: Increasing insulin resistance was observed alongside no change in insulin sensitivity variability, implying greater insulin needs but equivalent (variability) challenge to glycaemic control. Increasing insulin resistance may imply greater inflammation and severity of illness not captured by existing severity scores. Insulin resistance reduces glucose tolerance, and can cause greater incidence of insulin saturation and resultant hyperglycaemia. Overall, these results have significant clinical implications for glycaemic control and nutrition management.
نوع الوثيقة: article in journal/newspaper
وصف الملف: application/pdf
اللغة: English
تدمد: 2042-0188
2042-0196
العلاقة: Knopp JL, Chase JG, Shaw GM (2021). Increased insulin resistance in intensive care: longitudinal retrospective analysis of glycaemic control patients in a New Zealand ICU. Therapeutic Advances in Endocrinology and Metabolism. 12. 20420188211012144-.; https://hdl.handle.net/10092/104291Test; http://doi.org/10.1177/20420188211012144Test
DOI: 10.1177/20420188211012144
الإتاحة: https://doi.org/10.1177/20420188211012144Test
https://hdl.handle.net/10092/104291Test
حقوق: Creative Commons Non Commercial CC BY-NC: This article is distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 License (https://creativecommons.org/licenses/by-nc/4.0Test/) which permits non-commercial use, reproduction and distribution of the work without further permission provided the original work is attributed as specified on the SAGE and Open Access pages (https://us.sagepub.com/en-us/nam/open-access-at-sageTest). ; http://hdl.handle.net/10092/17651Test
رقم الانضمام: edsbas.FC2B89D9
قاعدة البيانات: BASE
الوصف
تدمد:20420188
20420196
DOI:10.1177/20420188211012144