TY - JOUR
T1 - Incretins in the ICU
T2 - is insulin on its way out?
AU - Kovalaske, Michelle A.
AU - Gandhi, Gunjan Y.
PY - 2009
Y1 - 2009
N2 - Incretins such as glucagon-like peptide-1 (GLP-1) are gut-derived hormones that stimulate insulin secretion and suppress glucagon secretion, thus playing a key role in glucose homeostasis. While incretin mimetics and enhancers are approved for treatment of outpatients with diabetes, evidence is only starting to accumulate regarding the therapeutic potential of incretins in hospitalized patients. Small exploratory studies suggest that GLP-1 safely reduces hyperglycemia without causing hypoglycemia, a key advantage over insulin if efficacy is established in larger studies. Potential limitations include the need for a continuous infusion for delivery, attenuation but not normalization of glucose levels, increased deceleration of gastric emptying and nausea. The exact mechanism of action, dosing, adverse effects, patient subgroups that would be most suitable and safety of combination treatment with insulin remain to be studied. While promising, additional research is required studying effects on hard clinical endpoints.
AB - Incretins such as glucagon-like peptide-1 (GLP-1) are gut-derived hormones that stimulate insulin secretion and suppress glucagon secretion, thus playing a key role in glucose homeostasis. While incretin mimetics and enhancers are approved for treatment of outpatients with diabetes, evidence is only starting to accumulate regarding the therapeutic potential of incretins in hospitalized patients. Small exploratory studies suggest that GLP-1 safely reduces hyperglycemia without causing hypoglycemia, a key advantage over insulin if efficacy is established in larger studies. Potential limitations include the need for a continuous infusion for delivery, attenuation but not normalization of glucose levels, increased deceleration of gastric emptying and nausea. The exact mechanism of action, dosing, adverse effects, patient subgroups that would be most suitable and safety of combination treatment with insulin remain to be studied. While promising, additional research is required studying effects on hard clinical endpoints.
UR - http://www.scopus.com/inward/record.url?scp=75549090169&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=75549090169&partnerID=8YFLogxK
U2 - 10.1186/cc7913
DO - 10.1186/cc7913
M3 - Comment/debate
C2 - 19591659
AN - SCOPUS:75549090169
SN - 1364-8535
VL - 13
SP - 161
JO - Critical care (London, England)
JF - Critical care (London, England)
IS - 4
ER -