title: The influence of parenteral glutamine supplementation on glucose homeostasis in critically ill polytrauma patients--A randomized-controlled clinical study.
abstract: OBJECTIVE
  Rapid onset of resistance to insulin is a prominent component of stress metabolism in multiple trauma patients. Recent studies have clarified the role of amino acids (especially glutamine) in glucose transportation and the benefits of parenteral alanyl-glutamine supplementation (0.3-0.6 g/kg/day) in glucose homeostasis. The aims of this study are to evaluate the incidence of hyperglycemic episodes and the need for exogenous insulin to maintain stable glucose levels in critically ill polytrauma patients supplemented with parenteral glutamine dipeptide (Dipeptiven(®)) versus standard nutritional support.
  
  
  METHODS
  This was an open-label randomized-controlled trial of 82 polytrauma patients aged 20-60 years old, randomly assigned into two equal groups independent of sex, age and Injury Severity Score. We excluded patients with diabetes mellitus, or renal or hepatic failure. One group received parenteral Dipeptiven(®) supplementation of 0.5 g/kg/day and the other received standard isocaloric isoproteinic nutritional support.
  
  
  RESULTS
  We found that 63% of patients in the glutamine-supplemented group had no hyperglycemic episodes; only 37% required exogenous insulin (mean daily requirement of 44 units/day). In the control group, 51% of patients required insulin (mean daily requirement 63 unit/day; p = 0.0407).
  
  
  CONCLUSIONS
  The effect of glutamine supplementation on glucose homeostasis is associated with a lower incidence of hyperglycemia among critically ill polytrauma patients, and leads to a lower mean daily dose of insulin. Controlled-trials.com Identifier: ISRCTN71592366 (http://www.controlled-trials.com/ISRCTN71592366/ISRCTN71592366).
authors.affiliation: Clinical Emergency Hospital of Bucharest, Intensive Care and Anaesthesiology Department, Calea Floreasca nr. 8, Sector 1, Bucharest, 014461, Romania.
authors.forename: Ioana Marina
authors.initials: IM
authors.lastname: Grintescu
authors.affiliation: Clinical Emergency Hospital of Bucharest, Intensive Care and Anaesthesiology Department, Calea Floreasca nr. 8, Sector 1, Bucharest, 014461, Romania. Electronic address: irinaluc@yahoo.com.
authors.forename: Irina
authors.initials: I
authors.lastname: Luca Vasiliu
authors.affiliation: Clinical Emergency Hospital of Bucharest, Intensive Care and Anaesthesiology Department, Calea Floreasca nr. 8, Sector 1, Bucharest, 014461, Romania.
authors.forename: Ioana
authors.initials: I
authors.lastname: Cucereanu Badica
authors.affiliation: Clinical Emergency Hospital of Bucharest, Intensive Care and Anaesthesiology Department, Calea Floreasca nr. 8, Sector 1, Bucharest, 014461, Romania.
authors.forename: Liliana
authors.initials: L
authors.lastname: Mirea
authors.affiliation: Clinical Emergency Hospital of Bucharest, Intensive Care and Anaesthesiology Department, Calea Floreasca nr. 8, Sector 1, Bucharest, 014461, Romania.
authors.forename: Daniela
authors.initials: D
authors.lastname: Pavelescu
authors.affiliation: Clinical Emergency Hospital of Bucharest, Intensive Care and Anaesthesiology Department, Calea Floreasca nr. 8, Sector 1, Bucharest, 014461, Romania.
authors.forename: Andreea
authors.initials: A
authors.lastname: Balanescu
authors.affiliation: Clinical Emergency Hospital of Bucharest, Intensive Care and Anaesthesiology Department, Calea Floreasca nr. 8, Sector 1, Bucharest, 014461, Romania.
authors.forename: Ioana Cristina
authors.initials: IC
authors.lastname: Grintescu
mesh_terms: D000293:Adolescent; D000328:Adult; D000596:Amino Acids / Q000008:administration & dosage; D001786:Blood Glucose / Q000378:metabolism*; D016638:Critical Illness / Q000628:therapy*; D004040:Dietary Carbohydrates / Q000008:administration & dosage; D004041:Dietary Fats / Q000008:administration & dosage; D019587:Dietary Supplements; D004151:Dipeptides / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D005973:Glutamine / Q000008:administration & dosage*; D006706:Homeostasis; D006801:Humans; D006943:Hyperglycemia / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000097:blood / Q000628:therapy*; D010288:Parenteral Nutrition; D055815:Young Adult
chemical_list: D000596:Amino Acids; D001786:Blood Glucose; D004040:Dietary Carbohydrates; D004041:Dietary Fats; D004151:Dipeptides; D005973:Glutamine; C054122:alanylglutamine
keywords: Critically ill patient; Glutamine dipeptides; Hyperglycemia; Insulin; Parenteral nutrition; Polytrauma