Impact of tight glucose control on circulating 3-hydroxybutyrate in critically ill patients
Abstract Background Recent evidence suggests a potentially protective effect of increasing ketone body availability via accepting low macronutrient intake early after onset of critical illness. The impact of blood glucose control with insulin on circulating ketones is unclear. Whereas lowering blood...
| Main Authors: | , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2021-10-01
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| Series: | Critical Care |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s13054-021-03772-6 |
| _version_ | 1818691383347642368 |
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| author | Jan Gunst Astrid De Bruyn Michael P. Casaer Sarah Vander Perre Lies Langouche Greet Van den Berghe |
| author_facet | Jan Gunst Astrid De Bruyn Michael P. Casaer Sarah Vander Perre Lies Langouche Greet Van den Berghe |
| author_sort | Jan Gunst |
| collection | DOAJ |
| description | Abstract Background Recent evidence suggests a potentially protective effect of increasing ketone body availability via accepting low macronutrient intake early after onset of critical illness. The impact of blood glucose control with insulin on circulating ketones is unclear. Whereas lowering blood glucose may activate ketogenesis, high insulin concentrations may have the opposite effect. We hypothesized that the previously reported protective effects of tight glucose control in critically ill patients receiving early parenteral nutrition may have been mediated in part by activation of ketogenesis. Methods This is a secondary analysis of 3 randomized controlled trials on tight versus liberal blood glucose control in the intensive care unit, including 700 critically ill children and 2748 critically ill adults. All patients received early parenteral nutrition as part of the contemporary standard of care. Before studying a potential mediator role of circulating ketones in improving outcome, we performed a time course analysis to investigate whether tight glucose control significantly affected ketogenesis and to identify a day of maximal effect, if any. We quantified plasma/serum 3-hydroxybutyrate concentrations from intensive care unit admission until day 3 in 2 matched subsets of 100 critically ill children and 100 critically ill adults. Univariable differences between groups were investigated by Kruskal-Wallis test. Differences in 3-hydroxybutyrate concentrations between study days were investigated by Wilcoxon signed-rank test. Results In critically ill children and adults receiving early parenteral nutrition, tight glucose control, as compared with liberal glucose control, lowered mean morning blood glucose on days 1–3 (P < 0.0001) via infusing insulin at a higher dose (P < 0.0001). Throughout the study period, caloric intake was not different between groups. In both children and adults, tight glucose control did not affect 3-hydroxybutyrate concentrations, which were suppressed on ICU days 1–3 and significantly lower than the ICU admission values for both groups (P < 0.0001). Conclusion Tight versus liberal glucose control in the context of early parenteral nutrition did not affect 3-hydroxybutyrate concentrations in critically ill patients. Hence, the protective effects of tight glucose control in this context cannot be attributed to increased ketone body availability. |
| first_indexed | 2024-12-17T12:41:01Z |
| format | Article |
| id | doaj.art-e35e9bd75b404581818058ca3a9209c7 |
| institution | Directory Open Access Journal |
| issn | 1364-8535 |
| language | English |
| last_indexed | 2024-12-17T12:41:01Z |
| publishDate | 2021-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Critical Care |
| spelling | doaj.art-e35e9bd75b404581818058ca3a9209c72022-12-21T21:48:02ZengBMCCritical Care1364-85352021-10-012511810.1186/s13054-021-03772-6Impact of tight glucose control on circulating 3-hydroxybutyrate in critically ill patientsJan Gunst0Astrid De Bruyn1Michael P. Casaer2Sarah Vander Perre3Lies Langouche4Greet Van den Berghe5Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenClinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenClinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenClinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenClinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenClinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, KU LeuvenAbstract Background Recent evidence suggests a potentially protective effect of increasing ketone body availability via accepting low macronutrient intake early after onset of critical illness. The impact of blood glucose control with insulin on circulating ketones is unclear. Whereas lowering blood glucose may activate ketogenesis, high insulin concentrations may have the opposite effect. We hypothesized that the previously reported protective effects of tight glucose control in critically ill patients receiving early parenteral nutrition may have been mediated in part by activation of ketogenesis. Methods This is a secondary analysis of 3 randomized controlled trials on tight versus liberal blood glucose control in the intensive care unit, including 700 critically ill children and 2748 critically ill adults. All patients received early parenteral nutrition as part of the contemporary standard of care. Before studying a potential mediator role of circulating ketones in improving outcome, we performed a time course analysis to investigate whether tight glucose control significantly affected ketogenesis and to identify a day of maximal effect, if any. We quantified plasma/serum 3-hydroxybutyrate concentrations from intensive care unit admission until day 3 in 2 matched subsets of 100 critically ill children and 100 critically ill adults. Univariable differences between groups were investigated by Kruskal-Wallis test. Differences in 3-hydroxybutyrate concentrations between study days were investigated by Wilcoxon signed-rank test. Results In critically ill children and adults receiving early parenteral nutrition, tight glucose control, as compared with liberal glucose control, lowered mean morning blood glucose on days 1–3 (P < 0.0001) via infusing insulin at a higher dose (P < 0.0001). Throughout the study period, caloric intake was not different between groups. In both children and adults, tight glucose control did not affect 3-hydroxybutyrate concentrations, which were suppressed on ICU days 1–3 and significantly lower than the ICU admission values for both groups (P < 0.0001). Conclusion Tight versus liberal glucose control in the context of early parenteral nutrition did not affect 3-hydroxybutyrate concentrations in critically ill patients. Hence, the protective effects of tight glucose control in this context cannot be attributed to increased ketone body availability.https://doi.org/10.1186/s13054-021-03772-6Tight glucose controlHyperglycemiaInsulinCritical illnessKetogenesisKetone body |
| spellingShingle | Jan Gunst Astrid De Bruyn Michael P. Casaer Sarah Vander Perre Lies Langouche Greet Van den Berghe Impact of tight glucose control on circulating 3-hydroxybutyrate in critically ill patients Critical Care Tight glucose control Hyperglycemia Insulin Critical illness Ketogenesis Ketone body |
| title | Impact of tight glucose control on circulating 3-hydroxybutyrate in critically ill patients |
| title_full | Impact of tight glucose control on circulating 3-hydroxybutyrate in critically ill patients |
| title_fullStr | Impact of tight glucose control on circulating 3-hydroxybutyrate in critically ill patients |
| title_full_unstemmed | Impact of tight glucose control on circulating 3-hydroxybutyrate in critically ill patients |
| title_short | Impact of tight glucose control on circulating 3-hydroxybutyrate in critically ill patients |
| title_sort | impact of tight glucose control on circulating 3 hydroxybutyrate in critically ill patients |
| topic | Tight glucose control Hyperglycemia Insulin Critical illness Ketogenesis Ketone body |
| url | https://doi.org/10.1186/s13054-021-03772-6 |
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