Mild hyperglycemia, but not glucagon-like peptide 1 predicts poor outcome after injury.

ABSTRACT

BACKGROUND: Loss of glucose homeostasis occurs frequently in injured patients. Glucagon-like peptide-1 (GLP-1) is a gut-derived incretin hormone that stimulates insulin and decreases glucagon secretion. The impact of the incretin system on glycemic control in injured patients has not been extensively studied. The aim of this study was to test the hypothesis that glycemic control in injured patients is influenced by circulating levels of GLP-1. METHODS: A prospective, observational pilot study was conducted at a state-designated level 1 trauma center. Patients with injuries requiring admission to the intensive care unit were eligible for inclusion. Patients with preinjury diabetes were excluded. Normoglycemic patients served as the control group. The hyperglycemic group consisted of patients with initial blood glucose levels > 150 mg/dL. Mann-Whitney and χ(2) tests were used for statistical analysis. RESULTS: Eleven controls and 19 hyperglycemic patients entered the study. The study group required ventilation more frequently (P = .047). Hyperglycemia (P = .029), but not GLP-1 level (P = .371), predicted mortality. GLP-1 levels varied greatly in both groups. CONCLUSIONS: GLP-1 levels varied in both control and hyperglycemic groups. Mortality and mechanical ventilation rates were higher in patients with hyperglycemia.