The use of exenatide in severely burned pediatric patients

Gabriel A. Mecott, David Herndon, Gabriela A. Kulp, Natasha C. Brooks, Ahmed M. Al-Mousawi, Robert Kraft, Haidy G. Rivero, Felicia N. Williams, Ludwik Branski, Marc G. Jeschke

Research output: Contribution to journalArticle

31 Citations (Scopus)

Abstract

Introduction: Intensive insulin treatment (IIT) has been shown to improve outcomes post-burn in severely burnt patients. However, it increases the incidence of hypoglycemia and is associated with risks and complications. We hypothesized that exenatide would decrease plasma glucose levels post-burn to levels similar to those achieved with IIT, and reduce the amount of exogenous insulin administered.Methods: This open-label study included 24 severely burned pediatric patients. Six were randomized to receive exenatide, and 18 received IIT during acute hospitalization (block randomization). Exenatide and insulin were administered to maintain glucose levels between 80 and 140 mg/dl. We determined 6 AM, daily average, maximum and minimum glucose levels. Variability was determined using mean amplitude of glucose excursions (MAGE) and percentage of coefficient of variability. The amount of administered insulin was compared in both groups.Results: Glucose values and variability were similar in both groups: Daily average was 130 ± 28 mg/dl in the intervention group and 138 ± 25 mg/dl in the control group (P = 0.31), MAGE 41 ± 6 vs. 45 ± 12 (respectively). However, administered insulin was significantly lower in the exenatide group than in the IIT group: 22 ± 14 IU patients/day in the intervention group and 76 ± 11 IU patients/day in the control group (P = 0.01). The incidence rate of hypoglycemia was similar in both groups (0.38 events/patient-month).Conclusions: Patients receiving exenatide received significantly lower amounts of exogenous insulin to control plasma glucose levels. Exenatide was well tolerated and potentially represents a novel agent to attenuate hyperglycemia in the critical care setting.Trial registration: NCT00673309.

Original languageEnglish (US)
Article numberR153
JournalCritical Care
Volume14
Issue number4
DOIs
StatePublished - Aug 11 2010

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Insulin
Pediatrics
Glucose
Burns
Hypoglycemia
exenatide
Control Groups
Incidence
Therapeutics
Critical Care
Random Allocation
Hyperglycemia
Hospitalization

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Medicine(all)

Cite this

Mecott, G. A., Herndon, D., Kulp, G. A., Brooks, N. C., Al-Mousawi, A. M., Kraft, R., ... Jeschke, M. G. (2010). The use of exenatide in severely burned pediatric patients. Critical Care, 14(4), [R153]. https://doi.org/10.1186/cc9222

The use of exenatide in severely burned pediatric patients. / Mecott, Gabriel A.; Herndon, David; Kulp, Gabriela A.; Brooks, Natasha C.; Al-Mousawi, Ahmed M.; Kraft, Robert; Rivero, Haidy G.; Williams, Felicia N.; Branski, Ludwik; Jeschke, Marc G.

In: Critical Care, Vol. 14, No. 4, R153, 11.08.2010.

Research output: Contribution to journalArticle

Mecott, GA, Herndon, D, Kulp, GA, Brooks, NC, Al-Mousawi, AM, Kraft, R, Rivero, HG, Williams, FN, Branski, L & Jeschke, MG 2010, 'The use of exenatide in severely burned pediatric patients', Critical Care, vol. 14, no. 4, R153. https://doi.org/10.1186/cc9222
Mecott GA, Herndon D, Kulp GA, Brooks NC, Al-Mousawi AM, Kraft R et al. The use of exenatide in severely burned pediatric patients. Critical Care. 2010 Aug 11;14(4). R153. https://doi.org/10.1186/cc9222
Mecott, Gabriel A. ; Herndon, David ; Kulp, Gabriela A. ; Brooks, Natasha C. ; Al-Mousawi, Ahmed M. ; Kraft, Robert ; Rivero, Haidy G. ; Williams, Felicia N. ; Branski, Ludwik ; Jeschke, Marc G. / The use of exenatide in severely burned pediatric patients. In: Critical Care. 2010 ; Vol. 14, No. 4.
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AU - Herndon, David

AU - Kulp, Gabriela A.

AU - Brooks, Natasha C.

AU - Al-Mousawi, Ahmed M.

AU - Kraft, Robert

AU - Rivero, Haidy G.

AU - Williams, Felicia N.

AU - Branski, Ludwik

AU - Jeschke, Marc G.

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N2 - Introduction: Intensive insulin treatment (IIT) has been shown to improve outcomes post-burn in severely burnt patients. However, it increases the incidence of hypoglycemia and is associated with risks and complications. We hypothesized that exenatide would decrease plasma glucose levels post-burn to levels similar to those achieved with IIT, and reduce the amount of exogenous insulin administered.Methods: This open-label study included 24 severely burned pediatric patients. Six were randomized to receive exenatide, and 18 received IIT during acute hospitalization (block randomization). Exenatide and insulin were administered to maintain glucose levels between 80 and 140 mg/dl. We determined 6 AM, daily average, maximum and minimum glucose levels. Variability was determined using mean amplitude of glucose excursions (MAGE) and percentage of coefficient of variability. The amount of administered insulin was compared in both groups.Results: Glucose values and variability were similar in both groups: Daily average was 130 ± 28 mg/dl in the intervention group and 138 ± 25 mg/dl in the control group (P = 0.31), MAGE 41 ± 6 vs. 45 ± 12 (respectively). However, administered insulin was significantly lower in the exenatide group than in the IIT group: 22 ± 14 IU patients/day in the intervention group and 76 ± 11 IU patients/day in the control group (P = 0.01). The incidence rate of hypoglycemia was similar in both groups (0.38 events/patient-month).Conclusions: Patients receiving exenatide received significantly lower amounts of exogenous insulin to control plasma glucose levels. Exenatide was well tolerated and potentially represents a novel agent to attenuate hyperglycemia in the critical care setting.Trial registration: NCT00673309.

AB - Introduction: Intensive insulin treatment (IIT) has been shown to improve outcomes post-burn in severely burnt patients. However, it increases the incidence of hypoglycemia and is associated with risks and complications. We hypothesized that exenatide would decrease plasma glucose levels post-burn to levels similar to those achieved with IIT, and reduce the amount of exogenous insulin administered.Methods: This open-label study included 24 severely burned pediatric patients. Six were randomized to receive exenatide, and 18 received IIT during acute hospitalization (block randomization). Exenatide and insulin were administered to maintain glucose levels between 80 and 140 mg/dl. We determined 6 AM, daily average, maximum and minimum glucose levels. Variability was determined using mean amplitude of glucose excursions (MAGE) and percentage of coefficient of variability. The amount of administered insulin was compared in both groups.Results: Glucose values and variability were similar in both groups: Daily average was 130 ± 28 mg/dl in the intervention group and 138 ± 25 mg/dl in the control group (P = 0.31), MAGE 41 ± 6 vs. 45 ± 12 (respectively). However, administered insulin was significantly lower in the exenatide group than in the IIT group: 22 ± 14 IU patients/day in the intervention group and 76 ± 11 IU patients/day in the control group (P = 0.01). The incidence rate of hypoglycemia was similar in both groups (0.38 events/patient-month).Conclusions: Patients receiving exenatide received significantly lower amounts of exogenous insulin to control plasma glucose levels. Exenatide was well tolerated and potentially represents a novel agent to attenuate hyperglycemia in the critical care setting.Trial registration: NCT00673309.

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