title: Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients.
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.
  
  
  METHODS
  Prospective, randomized, controlled trial.
  
  
  METHODS
  Intensive care unit of a tertiary level hospital.
  
  
  METHODS
  Multiple-trauma patients.
  
  
  METHODS
  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.
  
  
  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.
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, Charles University Third Faculty of Medicine, Kralovske Vinohrady Hospital, Prague, the Czech Republic.
authors.forename: Bohumil
authors.initials: B
authors.lastname: Bakalar
authors.forename: Frantisek
authors.initials: F
authors.lastname: Duska
authors.forename: Jan
authors.initials: J
authors.lastname: Pachl
authors.forename: Michal
authors.initials: M
authors.lastname: Fric
authors.forename: Michal
authors.initials: M
authors.lastname: Otahal
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Pazout
authors.forename: Michal
authors.initials: M
authors.lastname: Andel
mesh_terms: D000328:Adult; D001786:Blood Glucose / Q000187:drug effects; D004151:Dipeptides / Q000008:administration & dosage / Q000627:therapeutic use*; D004734:Energy Metabolism; D005260:Female; D015309:Glucose Clamp Technique; D006801:Humans; D007263:Infusions, Parenteral; D015601:Injury Severity Score; D007333:Insulin Resistance; D007362:Intensive Care Units; D008297:Male; D009104:Multiple Trauma / Q000145:classification / Q000188:drug therapy* / Q000378:metabolism
chemical_list: D001786:Blood Glucose; D004151:Dipeptides; C054122:alanylglutamine