Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients

Bakalář, Bohumil; Duška, František; Pachl, Jan; Fric, Michal; Otáhal, Michal; Pažout, Jaroslav; Andĕl, M

doi:10.1097/01.ccm.0000196829.30741.d4

Cited by 111 publications

(59 citation statements)

References 44 publications

(30 reference statements)

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“…This difference in glycemia levels could be due to the ability of glutamine to reduce insulin resistance in critically ill patients. This has also been recently confirmed by Bakalar et al 18 in an isotope study with hyperinsulinemic euglycemic clamp in severe trauma patients.…”

Section: Discussionsupporting

confidence: 67%

Preoperative glutamine infusion improves glycemia in heart surgery patients

Hissa¹,

Vasconcelos²,

Guimarães³

et al. 2011

Acta Cir. Bras.

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PURPOSE:To evaluate the effects of pre-operative L-alanyl-glutamine (L-Ala-Gln) on blood glucose control in patients with coronary obstruction, selected for myocardial revascularization. METHODS: Twenty-two patients (63±8 years) were randomly assigned to receive 250ml of L-Ala-Gln 20% plus saline 750 ml (Group L-Ala-Gln, n=11) or saline 1000 ml (Group Saline, n=11) over 3 hours before operation. Pre-operative blood samples were collected 3h before (T-1) and at the beginning of the surgical procedure (T-2). Intra-operative samples were collected immediately before the start (T-3) and the end of extra-corporeal perfusion (T-4). Post-operative samples were collected 12h (T-12) and 24h later (T-24). RESULTS: Glycemia decreased significantly in L-Ala-Gln treated patients during the intraoperative period. The same effect did not occur in saline patients. As the rate of insulin infusion, administered routinely to patients undergoing surgery with extracorporeal circulation was constant in both groups during surgery, the reduction of blood glucose in group L-Ala-Gln does not seem to be related to exogenous insulin. CONCLUSION: Pre-operative use of L-Ala-Gln improves glycemic control in patients with coronary artery occlusion, submitted to myocardial revascularization. Keywords: Glutamine. Blood Glucose. Metabolism. Coronary Artery Disease. Cardiovascular Surgical Procedures. RESUMO OBJETIVO:Avaliar os efeitos do uso pré-operatório da L-alanil-glutamina (L-Ala-Gln) no controle glicêmico em pacientes, selecionados para a revascularização do miocárdio. MÉTODOS: Vinte e dois pacientes cardiopatas (63±8 anos) foram randomizados para receber 250 ml de L-Ala-Gln 20% em 750 ml de solução salina (Grupo L-Ala-Gln, n=11) ou soro fisiológico 1000 ml (Grupo Salina, n=11). Amostras de sangue foram coletadas no pré-operatório, três horas antes (T-1: basal) e no início do procedimento cirúrgico (T-2); imediatamente antes do início (T-3) e no final da perfusão extra-corpórea (T-4); 12h (T-12) e 24h após a conclusão do procedimento. As infusões, com duração de 3 horas, foram iniciadas 3 h antes do procedimento operatório. RESULTADOS: Houve redução significativa da glicemia nos pacientes tratados com L-Ala-Gln durante o período intra-operatório (T-3 e T-4). O mesmo efeito não ocorreu nos pacientes do grupo salina. Como a taxa de infusão de insulina, administrada rotineiramente aos pacientes submetidos à cirurgia com circulação extracorpórea, foi constante em ambos os grupos durante o período intra-operatório, a redução da glicemia no grupo L-Ala-Gln não parece estar relacionada à insulina exógena. CONCLUSÃO: O uso pré-operatório de L-Ala-Gln melhora o controle glicêmico em pacientes com obstrução coronariana, submetidos à revascularização miocárdica.

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Section: Discussionsupporting

confidence: 67%

Preoperative glutamine infusion improves glycemia in heart surgery patients

Hissa¹,

Vasconcelos²,

Guimarães³

et al. 2011

Acta Cir. Bras.

View full text Add to dashboard Cite

show abstract

“…Despite this difference being statistically significant, we believe that this should not be clinically significant. Slightly lower insulin consumption in group 2 in comparison with group 3 could be explained by the effects of alanylglutamine on insulin sensitivity [21]. Whether different insulin doses might influence the IGF-I-IGFBP axis is not clear, as previous studies gave conflicting results [22,23].…”

Section: Discussionmentioning

confidence: 97%

Frequent intravenous pulses of growth hormone together with alanylglutamine supplementation in prolonged critical illness after multiple trauma: Effects on glucose control, plasma IGF-I and glutamine

Duška

Fric

Pažout

et al. 2008

Growth Hormone & IGF Research

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“…The effect of parenteral alanyl-glutamine on insulin resistance was investigated by Bakalar et al [ 70 ], who showed signifi cantly improved insulin sensitivity and insulin-mediated glucose disposal in the glutamine-supplemented patients. The rate of protein breakdown was not different between groups during the study, but hypermetabolism was attenuated in the glutamine group by reducing energy expenditure.…”

Section: Nitrogen Balance Protein Synthesis and Other Biochemical Oumentioning

confidence: 99%

Glutamine Supplementation in Multiple Trauma Patients

Balushi

Paratz

Cohen

et al. 2014

Glutamine in Clinical Nutrition

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Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients

Abstract: Parenteral supplementation of alanyl-glutamine dipeptide was associated with better insulin sensitivity in multiple-trauma patients.

Cited by 111 publications

References 44 publications

Preoperative glutamine infusion improves glycemia in heart surgery patients

Preoperative glutamine infusion improves glycemia in heart surgery patients

Frequent intravenous pulses of growth hormone together with alanylglutamine supplementation in prolonged critical illness after multiple trauma: Effects on glucose control, plasma IGF-I and glutamine

Glutamine Supplementation in Multiple Trauma Patients

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