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. 2020 Oct 15;10(5):237-245.
eCollection 2020.

Evaluation of the use of sitagliptin for insulin resistance in burn patients

Kaitlin A Pruskowski  1   2 , Beth A Shields  1 , Craig R Ainsworth  3 , Leopoldo C Cancio  1
Affiliations

Evaluation of the use of sitagliptin for insulin resistance in burn patients

Kaitlin A Pruskowski et al. Int J Burns Trauma. .

Abstract

Background: Following severe burn injury, patients undergo profound metabolic changes, including insulin resistance and hyperglycemia. Hyperglycemia has been linked to impaired wound healing, increased risk of skin graft loss, increased muscle catabolism, increased infections, and mortality. Sitagliptin is a dipeptidyl peptidase-4 (DPP-4) inhibitor that improves glycemic control by slowing the inactivation of incretin hormones, increasing insulin synthesis and release from pancreatic beta cells and lowering glucagon secretion from pancreatic alpha cells. The objective of this study was to describe our institution's experience with using sitagliptin to help mitigate insulin resistance after burn injury.

Methods: This was a retrospective chart review that included 22 adult burn patients. Burn patients were prescribed sitagliptin regardless of their previous medical history of type 2 diabetes mellitus. Patients were included in this analysis if they were adults admitted for burn injury during a 13-month period and received at least 3 consecutive doses of sitagliptin. Patients were excluded if they did not have insulin use data 3 days pre- and 3 days post-sitagliptin initiation. The first day of sitagliptin initiation was considered day 0; data from day 0 were not included in either the pre- or post-sitagliptin analysis.

Results: In the 3 days prior to sitagliptin initiation, patients received a median of 114.3 units per day (IQR 49.1, 228) in an attempt to maintain a blood glucose goal of less than 180 mg/dL. In the 3 days after sitagliptin was started, exogenous insulin requirements significantly decreased to a median to 36.3 units per day (IQR 11.7, 95) (P=0.009). Seven patients were on insulin infusions at the time of sitagliptin initiation. After sitagliptin was started, it took a median of 3 days (IQR 2, 3.25) to be liberated from the insulin infusion. In terms of safety, there were two episodes of hypoglycemia (BG<70 mg/dL) after sitagliptin initiation, compared to three episodes prior to sitagliptin initiation (P=0.7).

Conclusion: The addition of sitagliptin to burn patients' medication regimens significantly reduced insulin requirements over a 3-day period and allowed liberation from insulin drips.

Keywords: Insulin resistance; hyperglycemia; sitagliptin.

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Conflict of interest statement

The opinions or assertions contained herein are the private views of the authors, and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.

Figures

Figure 1
Figure 1
Inclusion and exclusion criteria.
Figure 2
Figure 2
Insulin use over time.
Figure 3
Figure 3
Blood glucose by day.
Appendix A
Appendix A
Insulin infusion titration protocol.
See this image and copyright information in PMC

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