Rosiglitazone may assist with glycemic control in the ICU.
BACKGROUND
Hyperglycemia is a frequent sequela of critical illness. Rosiglitazone is an oral hypoglycemic agent of the thiazolinedione class. Thiazolinediones are known to activate peroxisome proliferator-activated receptor gamma (PPAR-gamma) that decreases inflammation in humans and decreases shock induced by zymosan in mice.


OBJECTIVE
Rosiglitazone can assist with hyperglycemic control in the intensive care unit (ICU).


METHODS
A hospital billing query identified patients prescribed rosiglitazone while in a major university ICU. Patients who received rosiglitazone as an outpatient prior to hospitalization were excluded. Glycemic control was determined by average daily blood glucose, 24-hour insulin dose, and number of patients requiring an insulin drip. Glycemic control was evaluated on days 0, 3, and 7. Student t test was used to compare means. Fisher exact testing was used to compare insulin regimen before and after starting rosiglitazone.


RESULTS
34 patients were identified. The average Acute Physiology and Chronic Health Evaluation (APACHE) II score was 17.2 +/- 4.4. Sixty-five percent were male, 62% were preexisting diabetics. The mean daily blood glucose was 159 +/- 30 mg/dL on day 0, 146 +/- 37 mg/dL on day 3, and 140 +/- 33 mg/dL on day 7 (P < .03 vs day 0). The mean 24-hour insulin dose was 80.6 +/- 87.9 U on day 0, 72.2 +/- 73.4 U on day 3, and 46.3 +/- 57.2 U on day 7 (P < .003 vs day 0). There was 1 major hypoglycemic event.


CONCLUSIONS
Rosiglitazone may assist glycemic control in the ICU. Despite recent concerns of cardiac safety, further research should be done to evaluate its potential as a short-term therapeutic agent in the ICU, given its anti-inflammatory and antishock profile.
Lissauer
Matthew
M
Department of Surgical Critical Care, University of Maryland Medical Center, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA. mlissauer@umm.ed
Feild
Carinda
C
Fasanmi
Foyin
F
Johnson
Steven B
SB
D018806:APACHE; D000046:Academic Medical Centers; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000188:drug therapy*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D047495:PPAR gamma / Q000819:agonists*; D000077154:Rosiglitazone; D045162:Thiazolidinediones / Q000627:therapeutic use*
D007004:Hypoglycemic Agents; D047495:PPAR gamma; D045162:Thiazolidinediones; D000077154:Rosiglitazone