title: Insulin resistance, glucagon-like peptide-1 and factors influencing glucose homeostasis in neonates.
abstract: OBJECTIVE
  To explore the relationships between postmenstrual age (PMA), insulin, C-peptide, glucagon and blood glucose concentrations (BGCs) in preterm and term neonates. To compare glucagon-like peptide-1 (GLP-1) concentrations in fed versus never-fed neonates.
  
  
  METHODS
  Observational.
  
  
  METHODS
  Dunedin Hospital Neonatal Intensive Care Unit, New Zealand.
  
  
  METHODS
  Term or preterm euglycaemic neonates (102) receiving routine blood tests (343 samples).
  
  
  METHODS
  None: plasma was obtained from surplus samples from routine clinical care.
  
  
  METHODS
  Insulin, C-peptide, GLP-1 and glucagon concentrations were measured in temporal association with BGC.
  
  
  RESULTS
  Insulin and C-peptide concentrations were elevated in very preterm infants (PMA≤32 weeks) and decreased to term; this relationship persisted when BGCs were accounted for. Generalised linear mixed models showed that insulin:C-peptide ratio and insulin:BGC ratio decreased significantly with increasing PMA (p<0.001). GLP-1 increased following initial oral feeds regardless of PMA (p<0.001).
  
  
  CONCLUSIONS
  Preterm neonates exhibit insulin resistance in the absence of hyperglycaemia. Enteral feeds result in an increase in GLP-1. These factors are likely to contribute to the increased risk of hyperglycaemia in premature neonates (PMA<32 weeks).
authors: New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand.
authors: Emma R
authors: ER
authors: Salis
authors: Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors: David M
authors: DM
authors: Reith
authors: Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors: Benjamin J
authors: BJ
authors: Wheeler
authors: Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
authors: Roland S
authors: RS
authors: Broadbent
authors: New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand.
authors: Natalie J
authors: NJ
authors: Medlicott
mesh_terms: D001786:Blood Glucose / Q000378:metabolism*; D002096:C-Peptide / Q000097:blood; D005260:Female; D005934:Glucagon / Q000097:blood; D052216:Glucagon-Like Peptide 1 / Q000097:blood*; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007328:Insulin / Q000097:blood; D007333:Insulin Resistance / Q000502:physiology*; D007363:Intensive Care Units, Neonatal; D008297:Male; D009520:New Zealand
chemical_list: D001786:Blood Glucose; D002096:C-Peptide; D007328:Insulin; D052216:Glucagon-Like Peptide 1; D005934:Glucagon
keywords: GLP-1; glucagon; hyperglycaemia; insulin; neonate