Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients

Bakalar, Bohumil; Duska, Frantisek; Pachl, Jan; Fric, Michal; Otahal, Michal; Pazout, Jaroslav; Andel, Michal

doi:10.1097/01.ccm.0000196829.30741.d4

Cited by 136Clinical Nutrition and GastroenterologyHyperglycemia and glycemic control in critically ill and hospitalized patientsTrauma, Hemostasis, Coagulopathy, Resuscitation

Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients

Bakalar, Bohumil, Duska, Frantisek, Pachl, Jan, Fric, Michal, Otahal, Michal, Pazout, Jaroslav, Andel, Michal·2006·Critical Care Medicine

DOI 10.1097/01.ccm.0000196829.30741.d4

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Abstract

BACKGROUND: Dipeptide alanyl-glutamine is a commonly used substrate in major trauma patients. Its importance and effects are widely discussed; as yet, it has not been elucidated whether its administration influences glucose homeostasis. OBJECTIVE: We studied the effect of alanyl-glutamine administration on insulin resistance. DESIGN: Prospective, randomized, controlled trial. SETTING: Intensive care unit of a tertiary level hospital. PATIENTS: Multiple-trauma patients. INTERVENTIONS: Patients were randomized into two groups and assigned to receive parenterally an equal dose of amino acids either with alanyl-glutamine in the dose of 0.4 g x kg body weight(-1) x 24 hrs(-1) (group AG) or without alanyl-glutamine (control group C). This regimen started 24 hrs after injury and continued for 7 days. To assess insulin sensitivity, we performed an euglycemic clamp on day 4 and day 8 after injury. MEASUREMENTS AND MAIN RESULTS: We randomized 40 patients, 20 into each group. At day 4, insulin-mediated glucose disposal was higher in group AG (2.4 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference from group C (1.9 +/- 0.6 mg x kg(-1) x min(-1), p = .044). At day 8, glucose disposal was higher in group AG (2.2 +/- 0.7 mg x kg(-1) x min(-1) glucose), with significant difference in comparison with group C (1.2 +/- 0.6, p < .001). Diminution of the main glucose homeostasis variables in group C between days 4 and 8 of the study was statistically significant (p < .001); however, differences in these variables in group AG were without statistical significance. CONCLUSIONS: Parenteral supplementation of alanyl-glutamine dipeptide was associated with better insulin sensitivity in multiple-trauma patients.

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Glutamine supplementation can offer a therapeutic approach for critical illnesses.
“Under these conditions, several studies have reported that glutamine supplementation can offer a therapeutic approach for these critical illnesses145–147.”
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Authors: Bakalar, B., Duska, F., Pachl, J., Fric, M., Otahal, M., Pazout, J., & Andel, M.
Affiliations: Charles University (CZ)
Venue: Critical Care Medicine
Publisher: Ovid Technologies (Wolters Kluwer Health)
Published: 2006-02
Volume: 34
Issue: 2
Pages: 381-386
ISSN: 0090-3493 (ISSN-L)
DOI: 10.1097/01.ccm.0000196829.30741.d4
OpenAlex: W2046222793
Cited by: 136
References: 46
Citations by year: 2026: 3 · 2025: 1 · 2024: 3 · 2023: 1 · 2022: 3 · 2021: 4 · 2020: 5 · 2019: 7 · 2018: 3 · 2017: 6 · 2016: 6 · 2015: 9 · 2014: 11 · 2013: 11 · 2012: 9
FWCI: 7.33
Type: journal article
Language: en
Open access: closed
Locations: Critical Care Medicine (publishedVersion)
PubMed (publishedVersion)
Topics: Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
Health Sciences › Medicine › Critical Care and Intensive Care Medicine › Trauma, Hemostasis, Coagulopathy, Resuscitation
Keywords: alanyl-glutamine, insulin sensitivity, insulin resistance, polytrauma, severe trauma, glucose homeostasis, euglycemic clamp, glucose disposal, intensive care
MeSH terms: Adult, Blood Glucose, Dipeptides, Energy Metabolism, Female, Humans, Infusions, Parenteral, Insulin Resistance, Intensive Care Units, Male, Multiple Trauma, Glucose Clamp Technique, Injury Severity Score

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Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients

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