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Insulin resistance, glucagon-like peptide-1 and factors influencing glucose homeostasis in neonates
  1. Emma R Salis1,
  2. David M Reith2,
  3. Benjamin J Wheeler2,
  4. Roland S Broadbent2,
  5. Natalie J Medlicott1
  1. 1New Zealand's National School of Pharmacy, University of Otago, Dunedin, New Zealand
  2. 2Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
  1. Correspondence to Emma R Salis, School of Pharmacy, University of Otago, P.O. Box 56, Dunedin 9054, New Zealand; emma.salis{at}otago.ac.nz

Abstract

Objectives 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.

Design Observational.

Setting Dunedin Hospital Neonatal Intensive Care Unit, New Zealand.

Patients Term or preterm euglycaemic neonates (102) receiving routine blood tests (343 samples).

Interventions None: plasma was obtained from surplus samples from routine clinical care.

Main outcome measures 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).

Conclusion 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).

  • neonate
  • hyperglycaemia
  • insulin
  • GLP-1
  • glucagon

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