Enteral nutrition and glucagon-like peptide-1 in intensive care unit patients

Abstract

Glucagon-like peptide-1 is a peptide with antihyperglycemic activity secreted from distal parts of the intestine in response to enteral feeding. It augments insulin secretion via increasing glucose sensitivity of pancreatic beta cells without the risk of hypoglycemia. Slowing of gastric emptying and suppression of appetite are the other mechanisms of action which potentiate its antihyperglycemic activity. It may also exert neuroprotective, cardioprotective, nephroprotective, and immunomodulatory effects via acting through GLP-1 receptors located on many vital organs. Dipeptidyl peptidase 4 (DPP4) inhibitors that inhibit its enzymatic destruction, thus prolonging its plasma half-life or GLP-1 analogues that are resistant to enzymatic destruction, have been introduced as alternative therapeutic options for type 2 diabetes mellitus (DM) recently. Inability of critically ill ICU patients to secrete sufficient amounts of GLP-1 has given the inspiration for studying GLP-1 based therapies on this group of patients for glucose regulation and for its other potential benefits.