The effect of insulin administration on c-peptide in critically ill patients with type 2 diabetes

• DOI: 10.1186/s13613-017-0274-5
• Publication Date: 2017-05-12T02:19:12Z
• Authors: Marco Crisman; Luca Lucchetta; Nora Luethi; Luca Cioccari; Que Lam; Glenn M. Eastwood; Rinaldo Bellomo; Johan Mårtensson
• Keywords: RC86-88.9; Research; 610; Medical emergencies. Critical care. Intensive care. First aid; 3. Good health; 03 medical and health sciences; Diabetes mellitus; 0302 clinical medicine; Critical care, beta-cell; 616; Blood glucose; Insulin; C-peptide

In critically ill patients with permissive hyperglycemia, it is uncertain whether exogenous insulin administration suppresses or enhances c-peptide secretion (a marker of pancreatic beta-cell response). We aimed to explore this effect in patients with type 2 diabetes.We prospectively enrolled a cohort of 45 critically ill patients with type 2 diabetes managed according to a liberal glucose protocol (target blood glucose 10-14 mmol/l). We recorded the administration of insulin and oral hypoglycemic agents and measured plasma c-peptide as surrogate marker of endogenous insulin secretion on the first two consecutive days in ICU.Overall, 20 (44.4%) patients required insulin to achieve target blood glucose. Insulin-treated patients had higher glycated hemoglobin A1c, more premorbid insulin-requiring type 2 diabetes, and greater blood glucose levels but lower c-peptide levels on admission. Premorbid insulin-requiring diabetes was independently associated with lower admission c-peptide, whereas greater plasma creatinine was independently associated with higher levels. Increases in c-peptide were positively correlated with an increase in blood glucose both in patients who did (r = 0.54, P = 0.01) and did not (r = 0.56, P = 0.004) receive insulin. However, insulin administration was independently associated with a greater increase in c-peptide (P = 0.04). This association was not modified by the use of oral insulin secretagogues.C-peptide, a marker of beta-cell response, responds to and is influenced by glycemia and renal function in critically ill patients with type 2 diabetes. In addition, in our cohort, exogenous insulin administration was associated with a greater increase in c-peptide in response to hyperglycemia. Trial Registration Australian New Zealand Clinical Trials Registry (ACTRN12615000216516).