Insulin resistance postburn: underlying mechanisms and current therapeutic strategies.
The profound hypermetabolic response to burn injury is associated with insulin resistance and hyperglycemia, significantly contributing to the incidence of morbidity and mortality in this patient population. These responses are present in all trauma, surgical, or critically ill patients, but the severity, length, and magnitude is unique for burn patients. Although advances in therapeutic strategies to attenuate the postburn hypermetabolic response have significantly improved the clinical outcome of these patients during the past years, therapeutic approaches to overcome stress-induced hyperglycemia have remained challenging. Intensive insulin therapy has been shown to significantly reduce morbidity and mortality in critically ill patients. High incidence of hypoglycemic events and difficult blood glucose titrations have led to investigation of alternative strategies, including the use of metformin, a biguanide, or fenofibrate, a peroxisome proliferator-activated receptor (PPAR)-gamma agonist. Nevertheless, weaknesses and potential side affects of these drugs reinforces the need for better understanding of the molecular mechanisms underlying insulin resistance postburn that may lead to novel therapeutic strategies further improving the prognosis of these patients. This review aims to discuss the mechanisms underlying insulin resistance induced hyperglycemia postburn and outlines current therapeutic strategies that are being used to modulate hyperglycemia after thermal trauma.
Gauglitz
Gerd G
GG
Shriners Burns Hospital for Children, Galveston, Texas 77550, USA.
Herndon
David N
DN
Jeschke
Marc G
MG
D001786:Blood Glucose / Q000187:drug effects*; D002056:Burns / Q000150:complications* / Q000378:metabolism* / Q000503:physiopathology; D011345:Fenofibrate / Q000627:therapeutic use; D006801:Humans; D006943:Hyperglycemia / Q000209:etiology* / Q000378:metabolism / Q000517:prevention & control; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D007333:Insulin Resistance; D008687:Metformin / Q000627:therapeutic use; D047495:PPAR gamma / Q000187:drug effects / Q000378:metabolism; D012307:Risk Factors; D013997:Time Factors
D001786:Blood Glucose; D007004:Hypoglycemic Agents; D000960:Hypolipidemic Agents; D047495:PPAR gamma; D008687:Metformin; D011345:Fenofibrate