Comparison of peripheral metabolic effects of insulin and metformin following severe burn injury

Dennis Gore, David Herndon, Robert R. Wolfe, William G. Cioffi, Basil Pruitt

Research output: Contribution to journalArticle

39 Citations (Scopus)

Abstract

Objective: Both insulin and metformin have been shown to attenuate hyperglycemia and reduce net muscle protein catabolism following burn injury. The purpose of this study was to compare the peripheral metabolic effects of insulin and metformin in severe burn patients. Methods: Six adult patients with burns greater than 40% of their body surface underwent metabolic evaluation utilizing isotopic dilution of phenylalanine, femoral arterial and venous blood sampling, and sequential biopsies of leg muscle. Following baseline measurements, insulin was infused into the femoral artery at 0.45 mIU/min 100 mL leg volume. Patients were then given metformin (850 mg every 8 hours) for seven days with repeat metabolic evaluation before and during intra-arterial infusion of insulin. Results: Intra-arterial administration of insulin significantly increased insulin concentrations within the femoral vein, creating hyperinsulinemia localized to the extremity. Metformin had no significant effect on either peripheral glucose clearance or the rate of glucose oxidation. Furthermore, the availability of ATP and energy charge within muscle was not overtly affected by either insulin or metformin. Metformin did significantly increase the fractional synthetic rate of muscle protein which increased even further with insulin administration. Both metformin and insulin separately increased the rate of muscle protein synthesis as calculated using three compartment modeling. Conclusion: This study demonstrates a significant anabolic effect on muscle protein with metformin and a modest response with insulin. Findings also suggest that metformin and insulin may work synergistically to further improve muscle protein kinetics.

Original languageEnglish (US)
Pages (from-to)316-323
Number of pages8
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume59
Issue number2
DOIs
StatePublished - Aug 2005

Fingerprint

Metformin
Insulin
Wounds and Injuries
Muscle Proteins
Leg
Anabolic Agents
Glucose
Intra Arterial Infusions
Muscles
Femoral Vein
Hyperinsulinism
Femoral Artery
Thigh
Phenylalanine
Burns
Hyperglycemia
Extremities
Adenosine Triphosphate
Biopsy

Keywords

  • Glucose kinetics
  • Hypermetabolic response
  • Insulin resistance
  • Muscle protein

ASJC Scopus subject areas

  • Surgery

Cite this

Comparison of peripheral metabolic effects of insulin and metformin following severe burn injury. / Gore, Dennis; Herndon, David; Wolfe, Robert R.; Cioffi, William G.; Pruitt, Basil.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 59, No. 2, 08.2005, p. 316-323.

Research output: Contribution to journalArticle

Gore, Dennis ; Herndon, David ; Wolfe, Robert R. ; Cioffi, William G. ; Pruitt, Basil. / Comparison of peripheral metabolic effects of insulin and metformin following severe burn injury. In: Journal of Trauma - Injury, Infection and Critical Care. 2005 ; Vol. 59, No. 2. pp. 316-323.
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