Stress Hyperglycemia in Critically Ill Patients: Insight Into Possible Molecular Pathways

Frontiers in Medicine

article

David Bar-Or¹  Edward Brody⁷  Leonard T. Rael¹  Robert M. Madayag²  Kaysie L. Banton¹  Allen Tanner, II³  David L. Acuna⁴  Mark J. Lieser⁵  Gary T. Marshall⁶  Charles W. Mains² 

[1] Trauma Research Laboratory, Swedish Medical Center, United States;St. Anthony Hospital, United States;Penrose Hospital, United States;Wesley Medical Center, United States;Research Medical Center, United States;Medical City Plano Hospital, United States;SomaLogic Inc., United States

关键词: sepsis;    Warburg effect;    hyperglycemia;    glycolysis;    oxidative phosphorylation;    dipeptidyl peptidase IV;   

DOI  :  10.3389/fmed.2019.00054

学科分类：社会科学、人文和艺术（综合）

来源: Frontiers

【 摘 要 】

Severe sepsis, systemic inflammatory response syndrome (SIRS), and traumatic brain injury are frequently associated with hyperglycemia in non-diabetic patients. In patients suffering from any of these conditions, hyperglycemia at admission to an intensive care unit (ICU) is directly correlated with increased mortality or morbidity. Although there was initial enthusiasm for insulin treatment to blood glucose levels below 110 mg/dL in these patients, recent understanding suggests that the potential for hypoglycemic complications make this approach potentially dangerous. More moderate glucose control seems to be more beneficial than the aggressive glucose lowering initially suggested. An important publication has shown that hyperlactatemia accompanying hyperglycemia could be the real culprit in bad outcomes. This suggests that coupling moderate glucose lowering with therapeutic agents which might treat the underlying metabolic disturbances in these conditions may be a better strategy. The key metabolic disturbance in these three conditions seems to be persistent glycolysis as an energy source even in the presence of adequate tissue oxygenation (the Warburg Effect). We look at recent advances in understanding aerobic glycolysis and possibly the action of DPP4 on incretins resulting in insulin dysregulation and suggest key metabolic pathways involved in hyperglycemia regulation.

【 授权许可】

CC BY