BACKGROUND:Dipeptide alanyl-glutamine is a commonly used substrate in major trauma patients. Its importance and effects are widely discussed; as yet, it has not been elucidated whether its administration influences glucose homeostasis. OBJECTIVE: We studied the effect of alanyl-glutamine administration on insulin resistance. DESIGN: Prospective, randomized, controlled trial. SETTING:Intensive care unit of a tertiary level hospital. PATIENTS: Multiple-trauma patients. INTERVENTIONS: Patients were randomized into two groups and assigned to receive parenterally an equal dose of amino acids either with alanyl-glutamine in the dose of 0.4 g x kg body weight(-1) x 24 hrs(-1) (group AG) or without alanyl-glutamine (control group C). This regimen started 24 hrs after injury and continued for 7 days. To assess insulin sensitivity, we performed an euglycemic clamp on day 4 and day 8 after injury. MEASUREMENTS AND MAIN RESULTS: We randomized 40 patients, 20 into each group. At day 4, insulin-mediated glucose disposal was higher in group AG (2.4 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference from group C (1.9 +/- 0.6 mg x kg(-1) x min(-1), p = .044). At day 8, glucose disposal was higher in group AG (2.2 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference in comparison with group C (1.2 +/- 0.6, p < .001). Diminution of the main glucose homeostasis variables in group C between days 4 and 8 of the study was statistically significant (p < .001); however, differences in these variables in group AG were without statistical significance. CONCLUSIONS:Parenteral supplementation of alanyl-glutamine dipeptide was associated with better insulin sensitivity in multiple-trauma patients.
RCT Entities:
BACKGROUND:Dipeptidealanyl-glutamine is a commonly used substrate in major traumapatients. Its importance and effects are widely discussed; as yet, it has not been elucidated whether its administration influences glucose homeostasis. OBJECTIVE: We studied the effect of alanyl-glutamine administration on insulin resistance. DESIGN: Prospective, randomized, controlled trial. SETTING: Intensive care unit of a tertiary level hospital. PATIENTS: Multiple-traumapatients. INTERVENTIONS:Patients were randomized into two groups and assigned to receive parenterally an equal dose of amino acids either with alanyl-glutamine in the dose of 0.4 g x kg body weight(-1) x 24 hrs(-1) (group AG) or without alanyl-glutamine (control group C). This regimen started 24 hrs after injury and continued for 7 days. To assess insulin sensitivity, we performed an euglycemic clamp on day 4 and day 8 after injury. MEASUREMENTS AND MAIN RESULTS: We randomized 40 patients, 20 into each group. At day 4, insulin-mediated glucose disposal was higher in group AG (2.4 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference from group C (1.9 +/- 0.6 mg x kg(-1) x min(-1), p = .044). At day 8, glucose disposal was higher in group AG (2.2 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference in comparison with group C (1.2 +/- 0.6, p < .001). Diminution of the main glucose homeostasis variables in group C between days 4 and 8 of the study was statistically significant (p < .001); however, differences in these variables in group AG were without statistical significance. CONCLUSIONS: Parenteral supplementation of alanyl-glutamine dipeptide was associated with better insulin sensitivity in multiple-traumapatients.
Authors: Susan Cheng; Eugene P Rhee; Martin G Larson; Gregory D Lewis; Elizabeth L McCabe; Dongxiao Shen; Melinda J Palma; Lee D Roberts; Andre Dejam; Amanda L Souza; Amy A Deik; Martin Magnusson; Caroline S Fox; Christopher J O'Donnell; Ramachandran S Vasan; Olle Melander; Clary B Clish; Robert E Gerszten; Thomas J Wang Journal: Circulation Date: 2012-04-11 Impact factor: 29.690
Authors: Jon Pérez-Bárcena; Pedro Marsé; Arturo Zabalegui-Pérez; Esther Corral; Rubén Herrán-Monge; María Gero-Escapa; Mercedes Cervera; Juan Antonio Llompart-Pou; Ignacio Ayestarán; Joan Maria Raurich; Antonio Oliver; Antonio Buño; Abelardo García de Lorenzo; Guiem Frontera Journal: Intensive Care Med Date: 2014-02-21 Impact factor: 17.440
Authors: K Reinhart; F M Brunkhorst; H-G Bone; J Bardutzky; C-E Dempfle; H Forst; P Gastmeier; H Gerlach; M Gründling; S John; W Kern; G Kreymann; W Krüger; P Kujath; G Marggraf; J Martin; K Mayer; A Meier-Hellmann; M Oppert; C Putensen; M Quintel; M Ragaller; R Rossaint; H Seifert; C Spies; F Stüber; N Weiler; A Weimann; K Werdan; T Welte Journal: Ger Med Sci Date: 2010-06-28