Metformin blunts stress-induced hyperglycemia after thermal injury

Dennis Gore, Steven Wolf, David Herndon, Robert R. Wolfe

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

Background: Hyperglycemia is associated with detriments in immune function and impaired wound healing. The purpose of this study was to assess the effect of metformin, an oral antihyperglycemic agent approved for patients with diabetes mellitus, on glucose metabolism in severely burned patients. Methods: Metformin was given in a double-blind, placebo-controlled fashion to 10 patients, all with burns > 60% body surface area (age, 36 ± 4 years; weight, 92 ± 3 kg; mean ± SEM). After 8 days of metformin or placebo, glucose kinetics were quantitated using isotopic dilution with 6,6-d2 glucose and indirect calorimetry. Measurements were made during fasting; during an intravenous glucose infusion (30 μmol/kg/min); and during a hyperinsulinemic (500 mIU/m2/h), euglycemic clamp (mean plasma glucose concentration, 6.5 ± 0.3 mmol/L). Results: During fasting, metformintreated subjects had a significantly lower rate of endogenous glucose production (met. 9.6) and glucose oxidation than placebo control subjects. With the administration of intravenous glucose, metformin treatment significantly accelerated glucose clearance, thereby attenuating hyperglycemia. During hyperinsulinemia, glucose uptake was significantly greater in metformin-treated patients. Patients receiving metformin also had a significantly higher plasma concentration of insulin. Conclusion: These findings suggest a potential clinical efficacy of metformin to reduce stress-induced hyperglycemia by increasing glucose clearance. This effect may be mediated by either a metformin-induced augmentation of insulin sensitivity or by increasing insulin availability.

Original languageEnglish (US)
Pages (from-to)555-561
Number of pages7
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume54
Issue number3
DOIs
StatePublished - Mar 1 2003

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Metformin
Hyperglycemia
Hot Temperature
Glucose
Wounds and Injuries
Placebos
Fasting
Insulin
Indirect Calorimetry
Glucose Clamp Technique
Body Surface Area
Hyperinsulinism
Burns
Hypoglycemic Agents
Intravenous Infusions
Intravenous Administration
Wound Healing
Insulin Resistance
Diabetes Mellitus
Weights and Measures

Keywords

  • Critical injury
  • Glucose metabolism
  • Hypermetabolic response
  • Insulin

ASJC Scopus subject areas

  • Surgery

Cite this

Metformin blunts stress-induced hyperglycemia after thermal injury. / Gore, Dennis; Wolf, Steven; Herndon, David; Wolfe, Robert R.

In: Journal of Trauma - Injury, Infection and Critical Care, Vol. 54, No. 3, 01.03.2003, p. 555-561.

Research output: Contribution to journalArticle

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