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EXTREMELY PREMATURE NEONATES EXHIBIT INSULIN RESISTANCE
  1. Emma R Salis1,
  2. David M Reith2,
  3. Roland S Broadbent2,
  4. Benjamin J Wheeler2,
  5. Natalie J Medlicott1
  1. 1New Zealand's National School of Pharmacy, University of Otago, Dunedin
  2. 2Department of Women's and Children's Health, Dunedin School of Medicine, University of Otago, Dunedin

Abstract

Introduction Preterm birth disrupts normal timing of physiological adaptation of insulin secretion putting premature neonates at risk of abnormal glucose homeostasis. The insulin/C-peptide (I/CP) ratio gives an indication of insulin clearance but has not been reported in neonates. Premature neonates have significantly higher fasting levels of GLP-1 than adults that increase even further with feeding.

Aims To determine I/CP and insulin/blood glucose level (I/BGL) ratios in neonates and the effect of postmenstrual age (PMA) on these measures. To determine GLP-1 concentrations in never-fed versus fed neonates.

Methods Plasma samples were obtained from 102 neonates admitted to Dunedin Hospital NICU. Plasma was analysed for insulin and C-peptide using chemiluminescent kits (Invitron, UK), GLP-1 and glucagon using ELISA (BioCore Pty Ltd, Australia). Statistical analyses were performed using Stata/IC (v11.2).

Results The PMA range was 24–51.3 weeks. The median I/CP ratio was 0.44, 95% CI (0.44, 0.61). The median I/BGL ratio was 9.3, 95% CI (8.2, 10.6). Linear regressions of ln-transformed data were performed. I/CP and I/BGL ratios were significantly affected by PMA (p<0.01). Negative correlations were found (r=−0.21 and −0.35 for I/CP and I/BGL respectively, p<0.01) and I/CP changed around 34 weeks. Insulin concentrations were negatively correlated (r=−0.38, p<0.01) with increasing PMA. ANOVA showed higher GLP-1 concentrations (p=0.011) in fed versus never-fed neonates.

Conclusions These findings indicate insulin resistance in premature neonates prior to 34 weeks gestation. The significantly higher GLP-1 concentrations in fed neonates confirm that GLP-1 increases with the establishment of feeding.

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