title: Exogenous glucagon-like peptide-1 attenuates glucose absorption and reduces blood glucose concentration after small intestinal glucose delivery in critical illness.
abstract: OBJECTIVE
  To evaluate the effect of exogenous glucagonlike peptide-1 (GLP-1) on small intestinal glucose absorption and blood glucose concentrations during critical illness.
  
  
  METHODS
  A prospective, blinded, placebo-controlled, cross-over, randomised trial in a mixed medical-surgical adult intensive care unit, with 12 mechanically ventilated critically ill patients, who were suitable for receiving small intestinal nutrient.
  
  
  METHODS
  On consecutive days, in a randomised order, participants received intravenous GLP-1 (1.2 pmol/ kg/min) or placebo (0.9% saline) as a continuous infusion over 270 minutes. After 6 hours of fasting, intravenous infusions of GLP-1 or placebo began at T = -30 min (in which T = time), with the infusion maintained at a constant rate until study completion at T = 240 min. At T = 0 min, a 100 mL bolus of mixed liquid nutrient meal (1 kcal/mL) containing 3 g of 3-O-methyl-D-gluco-pyranose (3-OMG), a marker of glucose absorption, was administered directly into the small intestine, via a post-pyloric catheter, over 6 minutes.
  
  
  METHODS
  Blood samples were taken at regular intervals for the measurement of plasma glucose and 3-OMG concentrations.
  
  
  RESULTS
  Intravenous GLP-1 attenuated initial small intestinal glucose absorption (mean area under the curve [AUC]0-30for 3-OMG: GLP-1 group, 4.4 mmol/L/min [SEM, 0.9 mmol/L/min] v placebo group, 6.5 mmol/L/min [SEM, 1.0 mmol/L/min]; P = 0.01), overall small intestinal glucose absorption (mean AUC0-240for 3-OMG: GLP-1, 68.2 mmol/L/ min [SEM, 4.7 mmol/L/min] v placebo, 77.7 mmol/L/min [SEM, 4.4 mmol/lLmin]; P = 0.02), small intestinal glucose absorption and overall blood glucose concentration (mean AUC0-240for blood glucose: GLP-1, 2062 mmol/L/min [SEM, 111 mmol/L/min] v placebo 2328 mmol/L/min [SEM, 145 mmol/L/min]; P = 0.005).
  
  
  CONCLUSIONS
  Short-term administration of exogenous GLP-1 reduces small intestinal glucose absorption for up to 4 hours during critical illness. This is likely to be an additional mechanism for the glucose-lowering effect of this agent.
authors.affiliation: Assaf Harofeh Medical Center, Israel. Marianne.Chapman@sa.gov.au.
authors.forename: Asaf
authors.initials: A
authors.lastname: Miller
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Deane
authors.affiliation: Discipline of Acute Care Medicine, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Mark P
authors.initials: MP
authors.lastname: Plummer
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Caroline E
authors.initials: CE
authors.lastname: Cousins
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Lee-Anne S
authors.initials: LS
authors.lastname: Chapple
authors.affiliation: NHMRC Centre of Research Excellence in the Translation of Nutritional Science into Good Health, University of Adelaide, Adelaide, SA, Australia.
authors.forename: Michael
authors.initials: M
authors.lastname: Horowitz
authors.affiliation: Intensive Care Unit, Royal Adelaide Hospital, Adelaide, SA, Australia.
authors.forename: Marianne J
authors.initials: MJ
authors.lastname: Chapman
mesh_terms: D001786:Blood Glucose / Q000032:analysis*; D016638:Critical Illness; D018592:Cross-Over Studies; D005260:Female; D052216:Glucagon-Like Peptide 1 / Q000494:pharmacology*; D005947:Glucose / Q000008:administration & dosage / Q000378:metabolism*; D006801:Humans; D007408:Intestinal Absorption; D007421:Intestine, Small / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D016037:Single-Blind Method
chemical_list: D001786:Blood Glucose; D052216:Glucagon-Like Peptide 1; D005947:Glucose