Made Wiryana
Bagian Pendidikan Kedokteran dan Bagian/SMF Anestesi dan Terapi Intensif Fakultas Kedokteran Universitas Udayana/Rumah Sakit Umum Pusat Sanglah Denpasar Bali

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Journal : INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES

THE ROLE OF INTENSIVE INSULIN THERAPY ON SUPEROXIDE DISMUTASE (SOD), TUMOR NECROSIS FACTOR-? (TNF-?), AND INTERLEUKIN-6 (IL-6) ON HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS Wiryana, Made; Suastika, Ketut; Bagianto, Hari; Bakta, Made
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 4, No. 1 Januari 2010
Publisher : Udayana University

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Abstract

Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients?prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 ? 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients.
THE ROLE OF INTENSIVE INSULIN THERAPY ON SUPEROXIDE DISMUTASE (SOD), TUMOR NECROSIS FACTOR-? (TNF-?), AND INTERLEUKIN-6 (IL-6) ON HYPERGLYCEMIA IN CRITICALLY ILL PATIENTS Wiryana, Made; Suastika, Ketut; Bagianto, Hari; Bakta, Made
INDONESIAN JOURNAL OF BIOMEDICAL SCIENCES Vol. 3, No. 1 Januari 2009
Publisher : Udayana University

Show Abstract | Download Original | Original Source | Check in Google Scholar

Abstract

Hyperglycemia and insulin resistance are common in critically ill patientsin the ICU, although they have not previously had diabetes. It has been reportedthat pronounced hyperglycemia may lead to complications in such patients, andcause the reactive oxygen species (ROS) production, although controlled trial dataare still lacking. The current debatable issue, focusing on whether the intensiveinsulin therapy, aimed at normalizing blood glucose, may improvepatients?prognosis. Then, the debate is mainly about the time to start the therapy,and target of blood glucose level. Therefore, this research is mainly designed andaimed at knowing the difference between intensive insulin therapy andconventional insulin therapy on the increase of superoxide dismutase (SOD),decrease of cytokine production (TNF-? and IL-6), increase of albumin level, andevent of SIRSThis study was carried out in a randomly pre and post-test control groupdesign, involving 40 adult patients being nursed through the ICU Sanglah hospitalDenpasar. They were randomly assigned to receive intensive insulin therapy, inwhich blood glucose was decreased and maintained at the level between 80-110mg/dl, or conventional insulin therapy in which the insulin was infused only if theblood glucose level exceeded 215 mg/dl, decreased and maintained then at thelevel between 180-200 mg/dl.The result of the study showed that there was (1) significant increase ofSOD mean level (370. 70 vs 98.50 U/gHb, p=0.001); (2) no significant decreaseof TNF-? mean level; (3) significant decrease of IL-6 mean level (10.26 vs 2.25;p=0.023); (4) significant increase of albumin mean level ( 0.62 vs 0.22); (5)significant decrease of SIRS (10 % vs 40 %, p=0.000) on intensive insulin therapygroup compared to conventional insulin therapy group. It can be concluded thatintensive insulin therapy could maintain blood glucose level between 80 ? 110mg/dl, increase SOD level, decrease IL-6 level, increase albumin level, anddecrease SIRS on hyperglycemia in critically ill ICU patients.
Co-Authors - Yehezkiel, - Adinda Putra Pradhana, Adinda Adinda Putra Pradhana, Adinda Putra Andi Kusuma Wijaya, Andi Christopher Ryalino, Christopher Darminta, I Ketut Demoina, I Gede Patria Dewi, Dewa Ayu Mas Shintya Elisma Nainggolan, Elisma Emkel Perangin Angin, Emkel Gede Semarawima, Gede Hari Bagianto I Gede Budiarta, I Gede I Gusti Agung Gede Utara Hartawan, I Gusti Agung I Gusti Agung Gede Utara Hartawan, I Gusti Agung Gede I Gusti Agung Gede Utara Hartawan, I Gusti Agung Gede Utara I Gusti Ngurah Mahaalit Aribawa, I Gusti Ngurah I Gusti Ngurah Mahaalit Aribawa, I Gusti Ngurah Mahaalit I Gusti Putu Sukrana Sidemen, I Gusti Putu Sukrana I Ketut Sinardja I Made Darma Junaedi, I Made I Made Gde Widnyana, I Made Gde I Made Gede Widnyana I Made Gede Widnyana I Made Subagiartha I Nyoman Budi Hartawan I Nyoman Hariyasa Sanjaya I Wayan Aryabiantara, I Wayan IB Krisna Jaya Sutawan, IB Krisna Jaya Ida Bagus Gde Sujana, Ida Bagus Gde IGNA Putra Arimbawa, IGNA Putra Kadek Agus Heryana Putra, Kadek Agus Heryana Ketut Semara Jaya, Ketut Semara Ketut Suastika Kurnia, Prajnaariayi Prawira Made Adi Kusuma Made Agus Kresna Sucandra, Made Agus Kresna Made Bakta Made Widnyana, Made Marilaeta Cindryani, Marilaeta Ni Putu Novita Pradnyani, Ni Putu Ni Putu Wardani, Ni Putu Nyoman Sri Budayanti Okta, Ida Bagus Pande Nyoman Kurniasari, Pande Pontisomaya Parami, Pontisomaya Putu Agus Surya Panji, Putu Agus Putu Agus Surya Panji, Putu Agus Surya Putu Kurniyanta Putu Pramana Suarjaya Sinardja, Ketut Sonni Soetjipto, Sonni Sudewi, Anak Agung Raka Tjokorda Gde Agung Senapathi, Tjokorda Gde Tjokorda Gde Agung Senapathi, Tjokorda Gde Agung Tjokorda GdeAgung Senapathi, Tjokorda Usdyanto, Heavy Pradana