The effectiveness and safety of intensive insulin therapy, insulin sensitisers and insulin secretagogues for hypermetabolism in burn patients: A systematic review

Jared M. Campbell1, Rochelle Kurmis2, Zachary Munn3

1 The Joanna Briggs Institute, University of Adelaide, SA, 5005, jared.campbell@adelaide.edu
2 Adult Burns Centre, Royal Adelaide Hospital, 5000, Rochelle.Kurmis@sa.gov.au
3 The Joanna Briggs Institute, University of Adelaide, SA, 5005, Zachary.Munn@adelaide.edu.au

Background

Hypermetabolism in burn patients is associated with catabolism and hyperglycemia, which increase complications including mortality. Intensive insulin therapy (IIT) has been used to improve glucose uptake and ameliorate hypermetabolism. However, IIT can increase hypoglycaemia which can cause adverse patient outcomes. Medications for improving glucose control as an alternative carry lower risks of hypoglycaemia and include insulin sensitisers and insulin secretagogues.

Aim

To systematically review evidence regarding the safety and efficacy of IIT, insulin sensitisers and insulin secretagogues for hypermetabolism in burn patients.

Methods

PubMed, Embase, clinicaltrials.gov and Cochrane central were searched from April 2016 to January 1990. Title/abstract screening, full-text review, critical appraisal and data extraction were carried out by two independent reviewers.   Studies were included if they included hospitalised burn patients, investigated IIT an insulin sensitiser or secretagogue, and reported on mortality, resting energy expenditure, measures of blood glucose, catabolism, infection rates, or any adverse events. Meta-analysis was undertaken using RevMan.

Results

The search obtained 518 results, which was reduced to 429 following removal of duplicates. 21 full-text articles were retrieved, with 15 eligible for inclusion. Eight studies reported on adults and 7 on children who had sustained burn injuries. Eleven studies investigated IIT, 3 the insulin sensitiser metformin and 2 the secretagogues exenatide and fenofibrate. Meta-analyses of select outcomes will be presented.

Conclusion

Metabolic control is a critical issue in burn patients and changes in practice must be evidence based. Further evidence regarding methods of glycemic control other than exogenous insulin is required to provide potential adjuncts.

Key Words

Hypermetabolism, catabolism, hyperglycemia, insulin, Metabolic control

Biography

Jared Campbell is a research fellow at the Joanna Briggs Institute where he is academic lead of the burns care node.

About ANZBA

ANZBA is a not for profit organisation and the peak body for health professionals responsible for the care of the burn injured in Australia and New Zealand. ANZBA encourages higher standards of care through education, performance monitoring and research.

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