Association of adiponectin levels and insulin demand in critically ill patients

Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy Dovepress open access to scientific and medical research O r i g i n al R e s e a r c h Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy downloaded from https://www.dovepress.com/ by 37.59.46.207 on 13-Jul-2018 For personal use only. Open Access Full Text Article Association of adiponectin levels and insulin demand in critically ill patients This article was published in the following Dove Press journal: Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 25 January 2011 Number of times this article has been viewed Andreas Hillenbrand 1 Manfred Weiss 3 Uwe Knippschild 1 Hans G Stromeyer 1 Doris Henne-Bruns 1 Markus Huber-Lang 2,† Anna M Wolf 1,† 1 Department of General, Visceral, and Transplantation Surgery, 2 Department of Traumatology, Hand and Reconstructive Surgery, 3 Department of Anesthesiology, University Hospital of Ulm, Ulm, Germany † These authors contributed equally Purpose: Intensive care unit patients usually have a deregulated glucose homeostasis and present with hyperglycemia and hyperinsulinemia, suggesting overall insulin resistance. Adiponectin has significant anti-inflammatory and insulin-sensitizing effects and is diminished in morbidly obese and in critically ill patients. Reduced adiponectin could contribute to insulin resistance in these patients. We examined how far insulin demand in critically ill patients is correlated with patient adiponectin levels. Patients and methods: Adiponectin, resistin, leptin, insulin demand, minimal and maximal blood sugar levels, epinephrine, and hydrocortisone demand were measured 1 day after diagnosis of severe sepsis or septic shock in 25 patients (8 female, 17 male; median age 65 years; range: 31 to 87 years). Results: Insulin demand (range: 0–8 IU/h; median 3.5 IU) was positively correlated with serum adiponectin levels (median: 10.1 µg/mL; range: 2.9–47.6 µg/mL; r = +0.56, P , 0.01). There was no significant correlation between insulin demand and leptin serum levels (median: 18.1 ng/mL; range: 0.3–80.7 ng/mL; r = +0.29, P = 0.08) or resistin serum levels (median: 103.9 ng/mL; range: 14.7–352.3 ng/mL; r = +0.13, P = 0.27). Epinephrine demand (median: 0.08 µg/kg*min; range: 0.02–0.63 µg/kg*min) was negatively correlated with male adiponectin levels (r = -0.58; P , 0.01; females: r = −0.36; P = 0.19) and positively correlated with resistin levels (r = 0.43; P = 0.02). Patient body mass index (median 26 kg/m²; range: 18–37) was positively correlated with serum leptin (r = 0.60; P , 0.01) but was not correlated with insulin demand (r = 0.19; P = 0.19), or adiponectin (females: r = -0.37, P = 0.18; males: r = -0.16, P = 0.27), or resistin levels (r = +0.17; P = 0.21). Conclusion: Adiponectin levels and insulin demand were positively correlated during sepsis. Adiponectin levels were negatively correlated with epinephrine demand in male patients and epinephrine demand was positively correlated with resistin levels, which might have increased insulin resistance. The relationship between adiponectin and insulin action in humans is more complex than often suggested. Keywords: adipokines, sepsis, diabetes, resistin, leptin Introduction Correspondence: Andreas Hillenbrand Department of General, Visceral, and Transplantation Surgery, University Hospital of Ulm, Steinhoevelstr 9, 89075 Ulm, Germany Tel +49 731 500 53611 Fax +49731 500 53503 Email submit your manuscript | www.dovepress.com Dovepress DOI: 10.2147/DMSO.S15211 Powered by TCPDF (www.tcpdf.org) Patients who are critically ill often require prolonged intensive care and vital organ function support. These patients uniformly have a deregulated glucose homeostasis and present with hyperglycemia and hyperinsulinemia, suggesting overall insulin resistance. Maintaining normoglycemia with insulin therapy improves survival and reduces morbidity in surgical intensive care unit patients.1,2 Hyperglycemia in the presence of hyperinsulinemia also accompanies type 2 diabetes (T2DM), obesity, and the metabolic syndrome. These conditions are characterized by Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy 2011:4 45–51 45 © 2011 Hillenbrand et al, publisher and licensee Dove Medical Press Ltd. This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited. Dovepress Diabetes, Metabolic Syndrome and Obesity: Targets and Therapy downloaded from https://www.dovepress.com/ by 37.59.46.207 on 13-Jul-2018 For personal use only. Hillenbrand et al reduced inhibition of hepatic gluconeogenesis and impaired glucose uptake in insulin-sensitive tissues, such as skeletal muscle.3 These metabolic processes are influenced by products of the adipose tissue, so-called adipokines, which play a crucial role in the pathogenesis of the metabolic syndrome. Adipokine levels are changed in the morbidly obese and these changed levels contribute to skeletal muscle and hepatic insulin resistance.4 Adiponectin, the most abundant adipokine exclusively derived from adipocytes with higher average levels in females compared with males, has excited intense interest because of robust correlation of its circulating levels with insulin resistance and risk of T2DM. Further, adiponectin has a significant anti-inflammatory and insulin-sensitizing effect.5,6 We have already demonstrated that adipokines like adiponectin or leptin are shifted in critically ill patients in the same direction as in morbidly obese and patients with T2DM.7 Adiponectin has an unusual inverse relationship with body mass index (BMI) and thus is diminished in the obese, but also in the critically ill.7,8 Since reduced adiponectin levels seems to contribute to insulin resistance in the obese, reduced adiponectin levels could also contribute to insulin resistance in critically ill patients. Since higher adiponectin levels are associated with a lower risk of T2DM across diverse populations,9 we could speculate that higher adiponectin levels in critically ill patients cause a lower insulin demand. Therefore, in this study, we determined adiponectin, resistin, and leptin levels in critically ill patients and analyzed the insulin demand in correlation to patients’ adipokine levels. Materials and methods Patient characteristics Twenty-five patients who fulfilled the clinical criteria for severe sepsis or septic shock were enrolled in this study. Eight patients were female and 17 male, with a median age of 65 years (range: 31–87 years; female median age: 81 years, range: 42–87 years; male median age: 65 years, range: 31–83 years). The criteria for severe sepsis and septic shock were in accordance with those defined by Bone.10 The Simplified Acute Physiology Score (SAPS II) and Sequential Organ Failure Assessment score (SOFA) without Glasgow Coma Scale were used to define the severity of disease and organ dysfunctions, respectively.11–13 Total adiponectin, resistin, and leptin w (...truncated)