title: Microalbuminuria in hyperglycemic critically ill patients treated with insulin or metformin.
abstract: Microalbuminuria is thought to reflect the severity of inflammation-induced systemic vascular permeability. The present study investigated the effect of early administration of metformin or insulin on microalbuminuria in traumatized critically ill patients. Between April 2006 and October 2007, thirty-one non-diabetics traumatized patients with systemic inflammatory response syndrome (SIRS) and blood sugar (BS) >130 mg/dL at admission to ICU (Intensive Care Unit) of Sina Hospital (Tehran, Iran), were randomly assigned to receive intensive intravenous insulin (50 IU) or peroral metformin (1000 mg, twice daily) for three days. Microalbuminuria to creatinine ratio (MACR) and BS were measured during the three-day period. Eight patients were excluded during the study and 23 remained for the evaluations. There was no statistically significant difference between two groups with respect to MACR levels at admission and during the three-day period of treatment except for the time 6 and 48 h, that MACR was higher in insulin group than that in metformin group (p < 0.05). Metformin but not insulin reduced BS level significantly (p < 0.05). There was a significant positive correlation between BS and MACR in both insulin (p < 0.05; R(2) = 0.131) and metformin (p < 0.05; R(2) = 0.127) groups. Glasgow Coma Scale (GCS) and APACHE II had significant correlation with MACR in metformin treated patients (p < 0.05; R(2) = 0.134 and p < 0.05; R(2) = 0.149) while in insulin treated patients only the values of GCS had significant correlation with MACR values (p < 0.05, R(2) = 0.124). In conclusion, it was found that peroral metformin may be used instead of intravenous insulin in traumatized critically ill patients for lowering BS and MACR. A predictive role for MACR may be suggested although further studies with larger sample size of patients is required.
authors.affiliation: Research Center of Chemical Injuries, Baqiyatallah Medical Sciences University, Tehran, Iran.
authors.forename: Yunes
authors.initials: Y
authors.lastname: Panahi
authors.affiliation: Pharmaceutical Research Center, Tehran University of Medical Sciences, Tehran, Iran. ; Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Mojtahedzadeh
authors.affiliation: Nephrology and Urology Research Center, Baqiyatallah Medical Sciences University, Tehran, Iran.
authors.forename: Fatemeh
authors.initials: F
authors.lastname: Beiraghdar
authors.affiliation: ICU, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Atabak
authors.initials: A
authors.lastname: Najafi
authors.affiliation: ICU, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad-Reza
authors.initials: MR
authors.lastname: Khajavi
authors.affiliation: ICU, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Marzieh
authors.initials: M
authors.lastname: Pazouki
authors.affiliation: Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Nuria
authors.initials: N
authors.lastname: Zakeri
authors.affiliation: Department of Internal Medicine, Baqiyatallah Medical Sciences University, Tehran, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Saadat
authors.affiliation: DVM, ICU, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Mostafa
authors.initials: M
authors.lastname: Aghamohammadi
keywords: Insulin; Intensive Care Unit (ICU); Metformin; Microalbuminuria; Trauma