Sepsis uncouples serum C-peptide and insulin levels in critically ill patients with type 2 diabetes mellitus.

Bitker, Laurent; Cutuli, Salvatore L; Cioccari, Luca; Osawa, Eduardo A; Toh, Lisa; Luethi, Nora; Young, Helen; Peck, Leah; Eastwood, Glenn M; Mårtensson, Johan; Bellomo, Rinaldo (2019). Sepsis uncouples serum C-peptide and insulin levels in critically ill patients with type 2 diabetes mellitus. Critical care and resuscitation, 21(2), pp. 87-95. College of Intensive Care Medicine of Australia and New Zealand

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OBJECTIVE To assess the effects of sepsis and exogenous insulin on C-peptide levels and C-peptide to insulin ratios in intensive care unit (ICU) patients with type 2 diabetes mellitus (T2DM). DESIGN, SETTING AND PARTICIPANTS In this prospective, observational, single-centre study, we enrolled 31 ICU-admitted adults with T2DM. We measured serum C-peptide and insulin levels during the first 3 days of ICU stay and recorded characteristics of exogenous insulin therapy. Patients were compared on the basis of the presence of sepsis, and their exposure to exogenous insulin therapy. C-peptide levels were also measured in eight healthy subjects. MAIN OUTCOME MEASURES Serum insulin and C-peptide levels during the first 3 days in ICU. RESULTS Median C-peptide levels were higher in the ICU population compared with healthy subjects (10.9 [IQR, 8.2 -14.1] 4.8 [IQR, 4.6-5.1] nmol/L, < 0.01). Sepsis was present in 25 ICU patients (81%). Among ICU patients unexposed to exogenous insulin, the 11 patients with sepsis had higher median C-peptide levels compared with the six non-septic patients (2.5 [IQR, 1.8-3.7] 1.7 [IQR, 0.8-2.2] nmol/L, = 0.04), and a threefold higher C-peptide to insulin ratio (45 [IQR, 37-62] 13 [IQR, 11-17], = 0.03). However, septic patients exposed to exogenous insulin had lower median C-peptide levels (1.2 [IQR, 0.7-2.3] nmol/L, = 0.01) and C-peptide to insulin ratios (5 [IQR, 2-10], < 0.01) compared with insulin-free septic patients. The C-peptide to insulin ratio was significantly associated with white cell count and severity of illness in insulin-free septic patients. CONCLUSION C-peptide levels were elevated in critically ill patients with T2DM. In this population, sepsis increased C-peptide levels and uncoupled serum C-peptide and insulin levels. Exogenous insulin decreased both C-peptide levels and C-peptide to insulin ratios.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Intensive Care, Emergency Medicine and Anaesthesiology (DINA) > Clinic of Intensive Care

UniBE Contributor:

Cioccari, Luca

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1441-2772

Publisher:

College of Intensive Care Medicine of Australia and New Zealand

Language:

English

Submitter:

Mirella Aeberhard

Date Deposited:

22 Aug 2019 10:38

Last Modified:

22 Aug 2019 10:38

PubMed ID:

31142238

URI:

https://boris.unibe.ch/id/eprint/132186

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