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Randomized Controlled Trial
. 2017 Apr;26(2):239-246.
doi: 10.1007/s12028-016-0313-3.

Influence of Glycemic Control on Endogenous Circulating Ketone Concentrations in Adults Following Traumatic Brain Injury

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Free PMC article
Randomized Controlled Trial

Influence of Glycemic Control on Endogenous Circulating Ketone Concentrations in Adults Following Traumatic Brain Injury

Stephanie M Wolahan et al. Neurocrit Care. .
Free PMC article

Abstract

Background: The objective was to investigate the impact of targeting tight glycemic control (4.4-6.1 mM) on endogenous ketogenesis in severely head-injured adults.

Methods: The data were prospectively collected during a randomized, within-patient crossover study comparing tight to loose glycemic control, defined as 6.7-8.3 mM. Blood was collected periodically during both tight and loose glycemic control epochs. Post hoc analysis of insulin dose and total nutritional provision was performed.

Results: Fifteen patients completed the crossover study. Total ketones were increased 81 μM ([38 135], p < 0.001) when blood glucose was targeted to tight (4.4-6.1 mM) compared with loose glycemic control (6.7-8.3 mM), corresponding to a 60 % increase. There was a significant decrease in total nutritional provisions (p = 0.006) and a significant increase in insulin dose (p = 0.008).

Conclusions: Permissive underfeeding was tolerated when targeting tight glycemic control, but total nutritional support is an important factor when treating hyperglycemia.

Keywords: Glucose; Glycemic control; Insulin; Ketone bodies.

Figures

Figure 1
Figure 1
Nutritional therapy was reduced and insulin therapy was increased under tight glycemic control. A. Total nutritional provision in the preceding 24 hours decreased 8.3 kcal/kg ([3.0 13.6], p=0.006) between loose and tight. B. Enteral nutritional provision decreased 5.5 kcal/kg ([−0.5 11.4], p=0.066) between loose and tight. C. Insulin dose increased 1.3 IU/hr ([0.4 2.1], p=0.008) between loose and tight glycemic control. Data are presented as violin plots where the outside border estimates the shape of the data distribution; the horizontal black line plots the mixed effects model corrected estimate; the top and bottom of the rectangles the upper and lower 95% confidence intervals for the estimate, respectively; and the grey horizontal lines the Harrell-Davis estimates of first, second, and third quartiles from lowest to highest.

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