One of the immediate serious results of sudden extreme trauma or stress, including burns and even surgery, is insulin resistance, or diabetes. As a result, healing is delayed, especially in the case of severe burns, and since the body is unable to fully use blood sugar for energy, muscle tissue is broken down as the body scavenges for other possible energy sources.
However, children with severe flame burns of more than 40% body surface area showed “significantly improved whole body glucose uptake -- almost to normal levels -- after a two-week course of treatment with fenofibrate,” according to lead researcher, Melanie Green Cree at the University of Texas Medical Branch, Galveston. (The UTMB trauma center last week treated about 20 adult victims, including several with burns from the British Petroleum refinery after an explosion that killed at least 15 workers and injured dozens more.)
Cree said trauma in children “seems to cause problems with fat metabolism, which in turn may cause insulin resistance. This insulin resistance can be ameliorated with 10-14 days of fenofibrate treatment, and it may significantly improve morbidity outcomes, healing rates, and decrease time spent in the intensive care unit.”
Going into the experiment, “we felt that the fat metabolism in the children may be deranged by their burns,” Cree said. “We hoped that improving fat metabolism with fenofibrate, which is traditionally used to lower plasma triglycerides, would improve the insulin sensitivity. There is conflicting data about the relationship between glucose and fat metabolism. However, acute burn trauma seriously affects both glucose and fat metabolism, and our results show that by increasing cell mitochondrial fat metabolism with fenofibrate (marketed as Tricor by Abbott Laboratories), glucose metabolism can also be improved,” Cree reported.
The entire research team includes: Melanie Green Cree, Alse Aarsland, David Chinkes, David N. Herndon and Robert R. Wolfe from the University of Texas Medical Branch and Shriners Hospital for Children, Galveston.
Surprising 70% of serious burn victims show high insulin resistance
Working with children at the Shriners Hospital for Children, Galveston, the team found that when the children were admitted, “a surprising 70% of children with greater than a 40% total body surface area flame burns have an insulin sensitivity almost half that of healthy children. We wanted to understand why this diabetes develops and to see if medication could reduce it,” Cree said.
The study involved 18 child burn victims ages 4 to 14 years of age who were admitted within four days of injury to the Shriners tertiary burn center in Galveston. They were studied four days after their first and third excision and grafting surgeries. The patients were randomly assigned either to placebo or fenofibrate treatment after the first procedure. The fenofibrate (FEN) patients received 5mg/kg of fenofibrate once daily for 11±2 days. Whole body insulin sensitivity was measured with a clamp technique; stable isotopes of glucose were used to measure liver glucose release and leg glucose uptake was calculated from arterial and venous samples. “Both the liver and the muscle in the leg were examined to try to understand which organs were responsible for the changes in insulin sensitivity, Cree explained.