Parenterally administered dipeptide alanyl-glutamine prevents worsening of insulin sensitivity in multiple-trauma patients

BACKGROUND:Dipeptide alanyl-glutamine is a commonly used substrate in major trauma patients. Its importance and effects are widely discussed; as yet, it has not been elucidated whether its administration influences glucose homeostasis. OBJECTIVE:We studied the effect of alanyl-glutamine administration on insulin resistance. DESIGN:Prospective, randomized, controlled trial. SETTING:Intensive care unit of a tertiary level hospital. PATIENTS:Multiple-trauma patients. INTERVENTIONS:Patients were randomized into two groups and assigned to receive parenterally an equal dose of amino acids either with alanyl-glutamine in the dose of 0.4 g·kg body weight·24 hrs (group AG) or without alanyl-glutamine (control group C). This regimen started 24 hrs after injury and continued for 7 days. To assess insulin sensitivity, we performed an euglycemic clamp on day 4 and day 8 after injury. MEASUREMENTS AND MAIN RESULTS:We randomized 40 patients, 20 into each group. At day 4, insulin-mediated glucose disposal was higher in group AG (2.4 ± 0.7 mg·kg·min glucose), with significant difference from group C (1.9 ± 0.6 mg·kg·min, p = .044). At day 8, glucose disposal was higher in group AG (2.2 ± 0.7 mg·kg·min glucose), with significant difference in comparison with group C (1.2 ± 0.6, p < .001). Diminution of the main glucose homeostasis variables in group C between days 4 and 8 of the study was statistically significant (p < .001); however, differences in these variables in group AG were without statistical significance. CONCLUSIONS:Parenteral supplementation of alanyl-glutamine dipeptide was associated with better insulin sensitivity in multiple-trauma patients.